Posters

Anterior capsule and cortical lens discolouration with intracameral phenylephrine during cataract surgery

Poster Details

First Author: S. Balal UNITED KINGDOM

Co Author(s):    A. Sharma   N. Nesaratnam   J. Massie   N. Gnanapragasam   J. Than        

Abstract Details

Purpose:

Intraoperative preservative containing phenylephrine (PE) is used in cataract surgery to help dilate the pupil and/or make the iris more rigid in floppy iris syndrome. Preservatives are known to be toxic to the corneal endothelium. A safety alert was issued for intracameral epinephrine use because of corneal decompensation; the effect was attributed to the bisulfite preservative in the solution. Bisulfite is present in intracameral PE mixtures commonly used, including 'Minims preservative free'.

Setting:

Moorfields eye hospital, Bedford, United Kingdom

Methods:

We report 20 consecutive cases of intraoperative PE causing capsule and anterior cortical fibre staining. This is the first time this has been reported. Intracameral PE was used in all 20 patients to dilate the pupil. The intracameral PE was made by diluting 0.3mls PE 10% Minims to 2mls with balanced salt solution and adrenaline (1mg of adrenaline was added to 500mls of balanced salt solution). Approximately 0.2mls of the PE solution was used within 10 seconds.

Results:

The staining occurring in all 20 cases is the same. The images demonstrate one of these cases. There is initial staining of the capsule, followed by the anterior cortical lens fibres; this is irrespective of the type of cataract. The stain was limited to the area of contact with the capsule (the capsule under the iris did not stain). Removal of the anterior capsule also appeared to remove a large part of the stain.

Conclusions:

PE is known to cause cataracts and free radicals, the latter, along with preservatives in solution, may cause long term damage including to the endothelium. PE has not been associated with toxic anterior segment syndrome but may cause undocumented damage to the endothelium through its free radical mechanism. All our cases occurred without complication, though the endothelial cell count was not measured. The authors recommend judicious use and as dilute concentration as possible. Both our PE mixtures provided adequate pupil dilatation.

Financial Disclosure:

NONE