Abstract
Abstract Objective: To test the efficacy of Acetylcholine chloride use in obtaining intraoperative miosis on phacoemulsification cataract surgery. Methods: Patients with cataract diagnosis and elected for surgical phacoemulsification procedure were selected. All patients underwent conventional phacoemulsification procedure performed by a single surgeon and all patients had 0.2 ml of Acetylcholine chloride 1% irrigated in the anterior chamber at the end of the surgery. The pupillary diameter was measured immediately before the beginning of surgery, immediately before and two minutes after the use of acetylcholine chloride 1%. Results: A total of 30 eyes from 30 patients were included in the study. 18 were female, and mean age was of 69.5 years with a 7.2y standard deviation on the population study. The mean pupillary diameter immediately before the beginning of surgery was 7.5 mm with a standard deviation of 0.56 mm; the mean pupillary diameter immediately before the acetylcholine chloride 1% use (after the intraocular lens im-plantation) was 7.1 mm with a standard deviation of 0.57 mm. The mean pupillary diameter two minutes after the use of acetylcholine chloride 1% in the anterior chamber was 3.4 mm with standard deviation of 0.66 mm. The mean maximum action time of ACH chloride 1% was 64 seconds, with a standard deviation of 8 seconds. The mean intraocular pressure on the first postoperative day was 19.1 mmHg with a standard deviation of 2.45 mmHg. Conclusion: We conclude that acetylcholine chloride 1% is an important drug to obtaining intraoperative miosis in cataract surgery.
Highlights
Cholinergic agonists are drugs producing similar responses to Acetylcholine
The direct cholinergic agonists bind and activate cholinergic receptors in the juctions of the iris sphincter muscle promoting pupillary constriction.The Indirect Cho-linergicAgonists carry their effects primarily by inhibiting Acetylcholinesterase which in turn increases the available acetylcholine to the cholinergic receptors. (1)
Amsler and Verrey were the first to register the use of acetylcholine chloride to obtain intraoperative miosis after lens extraction. (3)
Summary
Cholinergic agonists are drugs producing similar responses to Acetylcholine. These are known as miotic or parasympathomimetic. Acetylcholine (ACH) chloride 1% is a direct agonist, being a neurohormone that mediates nervous signal transmission in all cholinergic sites involving autonomic and somatic nerves. Upon its release it is rapidly inactivated by the acetylcholinesterase en-zyme. Obtaining satisfactory miosis quickly and safely is often necessary and the direct irrigation of Acetylcholine Chloride 1% in the anterior chamber can produce a short-duration miosis and a regular pupil after the insertion of the intraocular lens. At the end of surgery, after intraocular lens implantation and viscoelastic aspiration from the anterior chamber, 0.2 ml of Acetylcholine chloride 1% (Ophthalmos - Industry and Commerce of Pharmaceu-tical Products®) was irrigated. All statistical analyses were performed using commercially available statistical software (SPSS version 21, SPSS, Inc., Chicago, IL)
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