Abstract
Miosis induced by surgical trauma is a frequent problem during extracapsular cataract surgery. In experimental surgery on rabbits, the inhibitory effect on pupillary constriction of cyclo-oxygenase inhibitors, local anesthetics, capsaicin (presumed substance P depletor), sympathomimetic agents, and anticholinergic agents were studied. In eyes predilated with tropicamide, iris massage caused marked pupillary constriction. Randomized pretreatment with the following agents significantly inhibited miosis: flurbiprofen, P < 0.005; topical anesthetics (benoxinate, P < 0.001, cocaine, P < 0.05, proparacaine, P < 0.005); and retrobulbar capsaicin, P < 0.005. No significant inhibition was shown with topical indomethacin aqueous solution (P < 0.15), topical tetracaine (P < 0.15), or retrobulbar lidocaine (P < 0.15). No single agent or combination of agents blocked the total miotic response; however, a combination of flurbiprofen, benoxinate, and capsaicin blocked more than two thirds of the miosis. Phenylephrine, a sympathomimetic (active) mydriatic agent, was more effective than anticholinergic (passive) mydriatic agents in obtaining maximal pupillary size after surgical iris massage.
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