Intraocular Irrigating Research Articles

Heparin in the intraocular irrigating solution in pediatric cataract surgery

Purpose: To investigate the antiinflammatory effects of adding heparin sodium to the irrigating solution to prevent fibrinoid reaction and related long-term complications after pediatric cataract surgery. Setting: Department of Ophthalmology, Inönü University, Turgut Özal Medical Center, Malatya, Turkey. Methods: Thirty eyes of 18 children who had cataract or other ocular surgery were included in the study. Bilateral cataract surgery was performed in 20 eyes of 10 children and bilateral secondary intraocular lens (IOL) implantation in 4 eyes of 2 children (Group 1). Four eyes of 4 children had unilateral cataract surgery and 2 eyes of 2 children with previous perforating eye injury had synechiotomy and pupilloplasty (Group 2). Heparin sodium was added to the irrigating solution during surgery in 12 left eyes of children with bilateral surgery (Group 1a) and in all eyes in Group 2. Heparin sodium was not added during surgery in 12 right eyes of children having bilateral surgery (Group 1b, control). Early and late postoperative intraocular reactions were recorded and compared. Results: In Group 1a (heparin added), 6 eyes had less fibrinoid reaction and fewer related complications such as posterior synechias, pupil irregularity, and intraocular lens (IOL) decentration than the fellow right eyes. No eye in Group 1a having primary cataract surgery had hyphema or intraocular bleeding. Hyphema occurred on the first postoperative day in 1 eye in Group 1a that had secondary IOL implantation. Conclusions: Adding heparin sodium to the irrigating solution decreased postoperative inflammatory and fibrinoid reactions and related complications such as synechias, pupil irregularity, and IOL decentration in pediatric cataract surgery. However, the use of heparin during surgery can be risky in eyes with a defective blood–aqueous barrier such as after previous ocular surgery.

Prednisolone and flurbiprofen drops to maintain mydriasis during phacoemulsification cataract surgery

Purpose: To compare the effects on the pupil of pretreatment with prednisolone 1% eyedrops, flurbiprofen 0.03% eyedrops, and sodium chloride 0.9% eyedrops in patients having phacoemulsification cataract surgery. Setting: Christopher Home Eye Unit, Royal Albert Edward Infirmary, Wigan, United Kingdom. Methods: One hundred thirty-six white patients having phacoemulsification with no history of eye disease, antiinflammatory medication, or diabetes were enrolled in this prospective randomized double-blind study. Patients were allocated to receive flurbiprofen 0.03%, prednisolone 1%, or sodium chloride 0.9% (placebo) eyedrops at 30-minute intervals beginning 2 hours before surgery. All patients received cyclopentolate 1% and phenylephrine 2.5% drops preoperatively and epinephrine 1:10 6 intraoperatively in the intraocular irrigating solution. The pupil diameter was measured from a television screen at the preset magnification of the operating microscope immediately before the incision, at the end of nucleus emulsification, at the end of irrigation/aspiration (I/A), and at the end of surgery. One hundred twelve patients with a baseline pupil diameter of at least 6.0 mm who had uneventful phacoemulsification were analyzed. Results: The baseline pupil diameters were statistically similar. An analysis of variance did not reveal an overall significant mydriasis-maintaining effect of prednisolone or flurbiprofen compared to the placebo at any stage of surgery ( P = .16 to .37). The 95% confidence interval showed flurbiprofen to be superior to prednisolone at the end of surgery. According to the paired t test, the reduction from the baseline at the end of I/A in the prednisolone group ( P = .051) and at the end of surgery in the flurbiprofen group ( P = .22) was not significant. Conclusion: In the presence of epinephrine in the intraocular irrigating solution, both prednisolone 1% and flurbiprofen 0.03% failed to maintain mydriasis at the crucial steps of nuclear emulsification and cortical I/A.

Removing silicone oil droplets from the posterior surface of silicone intraocular lenses

A 67-year-old woman had droplets of silicone oil adhering to her silicone intraocular lens (IOL) resulting from a previous silicone oil tamponade. A lens hook and intraocular irrigation were used in conjunction by inserting an infusion cannula to remove the droplets. This restored clarity of the visual axis, improved visual acuity, and eliminated the need for IOL replacement. The technique is simple and less invasive than IOL exchange and may become the preferred way to remove silicone droplets from an IOL.

Effect of cooled intraocular irrigatingsolution on the blood-aqueous barrier after cataract surgery

Purpose: To evaluate the effect of cooled intraocular irrigating solution during phacoemulsification on postoperative blood-aqueous. barrier (BAB) disturbance. Setting: Department of Ophthalmology, University of Vienna, Austria, Methods: In a prospective, randomized clinical study, 40 eyes with senile cataract had phacoemulsification with irrigating solutions cooled to approximately 10°C (n = 20) or at room temperature (n = 20). Surgical procedure and postoperative therapy were otherwise identical in both groups. Postoperative BAB disturbance was assessed with the laser flare-cell meter on days 1, 3, 7, 14, and 28. Results: Anterior chamber flare was significantly lower in the group with cooled irrigating solution on postoperative day 1. There was no significant between-group difference in flare on any other postoperative day. Conclusion: Cooled intraocular irrigating solution reduced immediate postoperative inflammation compared with irrigating solution at room temperature. However, this effect was of short duration.

Intracameral anesthesia: in vitro iris and corneal uptake and washout of 1% lidocaine hydrochloride.

To characterize the uptake, washout, and metabolism of lidocaine hydrochloride in the iris/ciliary body and cornea. Iris/ciliary body uptake of lidocaine hydrochloride was measured by incubating human and rabbit irides in radiolabeled carbon 14-1% lidocaine hydrochloride for 2 to 60 minutes. Washout was determined by incubating the iris in 14C-1% lidocaine hydrochloride for 5 minutes and transferring the iris to a series of wells. The wells contained a common intraocular irrigating solution of essential ions, glucose, and glutathione buffered with bicarbonate (an enriched balanced salt solution [BSS PLUS]), which is similar to aqueous humor. Corneal uptake was measured by exposing the endothelial surface to 14C-1% lidocaine hydrochloride for 5 or 15 minutes. Corneal washout was performed after 5-minute exposure to 14C-1% lidocaine hydrochloride using a 2-chambered diffusion apparatus. Samples of the iris, cornea, and BSS PLUS washout solution were analyzed by high-performance liquid chromatography and liquid scintillation spectrometry. In vitro iris/ciliary body uptake of 14C-1% lidocaine hydrochloride follows a logarithmic curve, with 50% to 60% of maximum lidocaine hydrochloride uptake present at 5 minutes. There was no difference in uptake between human, albino rabbit, and pigmented rabbit irides. Washout of lidocaine from the iris occurs with a halflife of 8 to 9 minutes. Corneal uptake of lidocaine was greater after incubation for 15 vs. 5 minutes. The washout of lidocaine from the cornea had a half-life of 5 minutes. Results of high-performance liquid chromatography confirmed that there were no metabolites or breakdown products in the iris, cornea, or washout solution. Lidocaine is taken up quickly by the iris/ ciliary body and cornea and rapidly removed from these tissues after BSS PLUS washout. Irrigation during phacoemulsification seems to limit lidocaine exposure to the ocular tissues, resulting in a short duration of anesthesia. Lidocaine is not metabolized or broken down by the iris or cornea during this short period.

Effect of Intraocular Irrigating Solution on Flicker Electroretinogram During Cataract Surgery in Human Eye

The effects of two commercially available intraocular irrigating solutions, Opeguard MA and BSS Plus, were studied during extracapsular cataract surgery in 45 eyes of 35 patients. After irrigation and aspiration of the residual cortex with Opeguard MA or BSS-Plus, the ERG amplitude increased, respectively, to 111.2 ± 5.8% and 109.5 ± 5.3% of the preirrigation amplitudes. The increases reached significance (116.9 ± 7.0% and 115.7 ± 6.5%; both P < .05) at the end of surgery compared with pre-irrigation ERG amplitudes. After irrigation with Opeguard MA or BSS-Plus, the ERG peak times were significantly prolonged to 103.9 ± 0.8% and 104.2 ± 1.2%, respectively, of the preirrigation peak times (both P < .01). The ERG peak times significantly shortened to 101.5 ± 0.9% and 101.3 ± 1.22%, respectively, at the end of surgery ( P < .001 and P < .05) compared with just after irrigation. Although we have previously shown that Opeguard MA maintained amplitude and implicit time of 30 Hz flicker ERG during vitrectomy better than BSS-Plus, there were no statistically significant differences between the changes in amplitude and peak time with Opeguard MA and BSS-Plus during cataract surgery. We speculate that a drop in the retinal temperature during irrigation and aspiration in the anterior chamber and an increase in the photopic ERG amplitude during light adaptation with the operating microscope caused these ERG changes.

Effect of supplemented and nonsupplementedvancomycin in the intraocular irrigating solutions onthe incidence of endophthalmitis afterphcoemulsification : A pilot study

Effect of supplemented and nonsupplementedvancomycin in the intraocular irrigating solutions onthe incidence of endophthalmitis afterphcoemulsification : A pilot study

Adhesiveness of AcrySof to a collagen film

Purpose: To measure the adhesiveness of the AcrySof® intraocular lens (IOL) to a collagen film to ascertain its capacity to adhere to the lens capsule.Setting: Haibara General Hospital, Haibara, and Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.Methods: Each of five AcrySof IOLs was attached to a collagen film, slightly pressed in intraocular irrigating solution, and then pulled up and off the film with a DuNouy's surface balance. The force recorded by the surface balance at the moment it detached from the film was defined as the lens' adhesiveness. A control experiment was performed using five conventional poly(methyl methacrylate) (PMMA) IOLs.Results: Mean adhesiveness was 2.76 gram-weight (gw) ± 0.55 (SD) for AcrySof and 0.81 ± 0.20 gw for PMMA. The difference was statistically significant (P < .0001, t-test).Conclusion: AcrySof may have a strong tendency to adhere to the lens capsule, contributing to posterior and anterior capsule clarity and preventing lens decentration in vivo.

Vancomycin prophylaxis and intraocular contamination during cataract surgery

Purpose: To investigate the effect of vancomycin added to the intraocular irrigation solution to prevent anterior chamber contamination during phacoemulsification.Setting: Centre Hospitalier, Villeneuve-Saint-Georges, France.Methods: A group of 372 patients having cataract extraction by phacoemulsification was divided into two consecutive, nonrandomized groups. The first group (n = 190) was a control; there was no antibiotic in the irrigation solution. The second group (n = 182) received vancomycin in the irrigation solution. Intraocular fluid was aspirated at the end of surgery and injected into a blood culture bottle to evaluate bacterial contamination of the anterior chamber.Results: There was no between-group difference in bacterial intraocular contamination. Eight samples in the first group were contaminated and nine in the second group. All contaminants were gram-positive vancomycin-sensitive organisms.Conclusions: Adding vancomycin to the intraocular irrigation solution during cataract surgery had no effect on the occurrence of intraocular contamination as evaluated by anterior chamber taps.

Intraocular irrigating solutions and barrier function of retinal pigment epithelium

AIMTo study the effect of intraocular irrigating solutions on the barrier property of the retinal pigment epithelium (RPE).METHODSThe isolated rabbit RPE–choroid mounted on Ussing-type chambers under short circuit conditions was...

Effect of intraocular irrigating solutions on the viability of cultured retinal vascular endothelial cells

Purpose. To compare the abilities of balanced salt solution, BSS Plus and Hartmann's lactated Ringer's (HLR) solution to maintain the viability of retinal vascular endothelial cells (RVEC) in vitro. Methods. Cultured retinal vascular endothelial cells were suspended in each irrigating solution for four hours. Viability was determined by trypan blue exclusion at 30 minute intervals. Regression analysis was used to determine the rate of viability loss. Additional studies were performed to determine the effectiveness of lactate in maintaining cell viability. Results. Retinal vascular endothelial cells lost viability at a greater rate (p < 0.001) in BSS (8.7%/hr) compared with BSS Plus (3.3%/hr). Cells in Hartmann's lactated Ringer's lost viability at a significantly lower rate (4.4%/hr) than retinal vascular endothelial cells in lactate-free Hartmann's lactated Ringer's solution (8.4%/hr). Lactate was as effective as glucose in preserving RVEC viability. By comparison, the viability of corneal endothelial cells was not effectively maintained by lactate. For these cells, BSS Plus was clearly superior to Hartmann's lactated Ringer's solution in maintaining viability. Conclusions. BSS Plus and Hartmann's lactated Ringer's solution are both superior to balanced salt solution in maintaining retinal vascular endothelial cell viability. For retinal vascular endothelial cells, Hartmann's lactated Ringer's solution preserves cell viability as well as BSS Plus, since the retinal vascular endothelial cells, unlike corneal endothelial cells, can apparently utilize lactate as an energy source.

A comparative study of intraocular irrigating solutions: effects on electroretinography readings during closed vitrectomy in humans.

The effects of intraocular irrigating solutions on electroretinography have been extensively studied in animal models, but effects on human electroretinography have not been reported. This study examined the effects of two commercially available irrigating solutions, S-MA2 (Opeguard MA) and DE-057 (BBS-Plus) on 30-Hz flicker electroretinography during closed vitrectomy in humans. Eight eyes of 8 patients were examined. All patients underwent a simple vitrectomy without treatment of proliferative membrane. For 30-Hz flicker electroretinography recording, a contact lens with a built-in light-emitting diode was sterilized and used as both a stimulus source and a recording electrode. Replacing S-MA2 with DE-057 decreased the electroretinography amplitude from 55.8 +/- 15.2 to 45.5 +/- 13.2 microV (mean +/- SEM). Changing the irrigation solution from DE-057 back to S-MA2 increased the amplitude from 45.5 +/- 13.2 to 59.9 +/- 17.3 microV. However, these changes were not statistically significant. Replacing S-MA2 with DE-057 significantly increased the peak time from 50.1 +/- 1.5 to 57.6 +/- 1.3 msec (p < 0.001). This change was reversible; after changing from DE-057 back to S-MA2, the peak time of flicker electroretinography significantly decreased from 57.6 +/- 1.3 to 49.0 +/- 2.1 msec (p < 0.01). Thus intraoperative 30-Hz electroretinography showed delayed peak time during irrigation with DE-057, as compared with S-MA2. The lower potassium concentration and higher glucose concentration of S-MA2, as compared with DE-057, may be the cause of such electroretinography changes.

An outbreak of Pseudomonas aeruginosa postoperative endophthalmitis caused by contaminated intraocular irrigating solution

Journal Article An outbreak of Pseudomonas aeruginosa postoperative endophthalmitis caused by contaminated intraocular irrigating solution Get access Witaya Swaddiwudhipong, Witaya Swaddiwudhipong ∗ 1Department of Community and Social Medicine, Mae Sot General Hospital, Tak 63110 Thailand ∗Author for correspondence. Search for other works by this author on: Oxford Academic PubMed Google Scholar Thasaporn Tangkitchot, Thasaporn Tangkitchot 2Department of Ophthalmology, Mae Sot General Hospital, Tak 63110, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Narumol Silarug Narumol Silarug 3Field Epidemiology Training Programme, Division of Epidemiology, Ministry of Public Health, Bangkok 10200, Thailand Search for other works by this author on: Oxford Academic PubMed Google Scholar Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 89, Issue 3, May-June 1995, Page 288, https://doi.org/10.1016/0035-9203(95)90545-6 Published: 01 June 1995 Article history Received: 12 December 1994 Accepted: 04 January 1995 Published: 01 June 1995

Intraocular gentamicin sulfate and postcataract anterior chamber aspirate cultures

We cultured anterior chamber aspirates of 28 patients who had uncomplicated cataract surgery. Fourteen patients had received 80 μg/ml of gentamicin in balanced salt solution through irrigation of the anterior chamber throughout cataract extraction, and 14 patients had received 8 μg/ml of gentamicin. Cultures of anterior chamber fluid obtained at the end of surgery from all 28 patients had no growth on two nonselective media. There was no clinical evidence of ocular toxicity. This study demonstrates that antibiotic in the intraocular irrigation fluid can reduce or eliminate the expected intraocular bacterial load after cataract surgery.

Intraocular adrenaline maintains mydriasis during cataract surgery.

Cataract surgery is performed more easily if mydriasis can be maintained until the intraocular lens has been inserted. Intraocular irrigation with adrenaline is thought to be of benefit in this respect, and is used by some surgeons but not others. This prospective double blind controlled trial assessed the efficacy and safety of using perioperative adrenaline during extracapsular cataract surgery, as an adjunct to preoperative topical mydriatics. Seventy patients were randomised to receive intraocular irrigation fluid with or without 1:1,000,000 adrenaline. The adrenaline entering the eye through the anterior capsulotomy needle helped to resist the miosis induced by expression of the nucleus (7.1 versus 6.5 mm). The mydriasis maintained during irrigation aspiration was significantly greater in the group receiving adrenaline (6.6 versus 6.0 mm, p < 0.02). Their pupil diameters were also significantly larger at 20 minutes (p < 0.001) and 30 minutes (p < 0.01) into surgery. Pupillary constriction to a diameter of less than 5 mm occurred more frequently in the group not receiving adrenaline. Pulse rate and blood pressure in the 27 patients who had local anaesthesia showed no significant difference between the treatment groups (p > 0.05), and there was no significant variation from baseline (p > 0.05). Intraocular irrigation with adrenaline 1:1,000,000 is a safe and effective means of maintaining mydriasis during cataract surgery.

A Prospective Randomized Double-Masked Clinical Comparison of Hartmann's Solution and Balanced Salt Solution in Phakoemulsification

OBJECTIVE: We wished to know the effect of two different intraocular irrigation fluids (Balanced Salt Solutioned (BSS) and Hartmann's Solution (HS)) on peroperative corneal transparency during phakoemulsification. STUDY DESIGN: This was a double-masked, randomized prospective trial of volunteer patients using an ethical-committee agreed protocol. SETTINGS: The study was undertaken in a teaching hospital cataract serice. PATIENTS: All patients had cataract and clinically normal corneas. Eighty-seven patients received BSS and 92 received HS. There was no statistically significant difference in age, sex or laterality between the two groups. MAIN OUTCOME MEASURES: We observed any loss of corneal transparency peroperatively. If this occurred, it was graded mild, moderate or severe. RESULTS: Moderate or severe corneal opacification was never seen in patients receiving BSS but occurred in 26 patients who received HS ( P < 0.00009). CONCLUSIONS: BSS is a much safer intraocular irrigation fluid for phakoemulsification in that it allows superior visualization by virtue of not causing loss of corneal transparency.

Corneal Edema from an Intraocular Irrigating Solution Containing Benzalkonium Chloride

AbstractAn intraocular irrigating solution developed in India (Irrisol) has been reported to cause immediate corneal edema when used during cataract surgery. The purpose of this study was to evaluate this intraocular irrigating solution for endothelial toxicity and compare it to balanced salt solution (BSS), a similar irrigating solution used in the United States. Human and rabbit corneas were mounted for in vitro specular microscopy and endothelium perfused with Irrisol and BSS.The results of this study showed that Irrisol caused immediate corneal swelling, with marked destruction of the corneal endothelial cells when observed with scanning and transmission electron microscopy. Further analysis showed that the Irrisol had a lower surface tension (35 dynes/cm) compared to BSS (73 dynes/cm). High-performance liquid chromatographic (HPLC) analysis confirmed that the lower surface tension and the endothelial damage were due to the addition of benzalkonium chloride (BAC) (0.009%) in the Irrisol intraocular ir...

Effects of BSS and BSS + Irrigation Solutions on Rabbit Corneal Transendothelial Electrical Potential Difference

Measurements of electrical potential difference across isolated rabbit corneal endothelium (transendothelial electrical potential difference, TEPD) were used to evaluate the effect of two commonly used commercially prepared intraocular irrigation balanced salt solutions, BSS and BSS+, together with our own standard bicarbonate-containing control solution (BS). The highest and most durable TEPD values were obtained by using BSS+; TEPD began at 550 microV, peaked at 600 microV 1 h later, and then decreased slowly down to some 300 microV after about 8 h. Gassing BSS+ with an air/5% CO2 mixture was optimal; gassing it with air reduced the TEPD values slightly, by about 10%. On the other hand, perfusion with BSS gassed with air had a rapid and marked adverse effect; the TEPD, which began at some 500 microV, fell down precipitously to about 50 microV after 1 hour. In contrast, perfusion with BSS on the endothelial side with the addition of BS to the stromal side, both sides being gassed with an air/5% CO2 mixture, maintained the TEPD at levels near those obtained with BSS+. We attribute the adverse effect by BSS to the absence of bicarbonate in it. From these and past results, we conclude that BSS cannot be recommended for intraocular use as a properly balanced saline solution.

The pH of Antibiotic Vitreous Infusion Combinations: A Potential Cause of Retinal Toxicity

Experiments were undertaken to measure the pH of solutions of commonly used intravitreal antibiotics in various irrigating solutions to determine whether a change in pH might be a factor in antibiotic-induced retinal toxicity. Such retinal toxicity has been particularly damaging when solutions of gentamicin have been used. The pHs of the following solutions were measured: gentamicin, amikacin, methicillin, tobramycin, and vancomycin, combined with balanced salt solution (BSS) PLUS (bicarbonate buffer), BSS (citrate/acetate buffer), and lactated Ringer's solution (lactate buffer). Each of these antibiotics induced a concentration-dependent decrease in pH of the solutions; gentamicin, amikacin and tobramycin produced the largest shifts. The results also demonstrated that BSS PLUS acts as the strongest buffer and lactated Ringer's as the weakest. We conclude that it is important to determine the pH of intraocular antibiotic irrigating solutions, not just the pH of the antibiotics.

Cataract surgical techniques and adjuncts.

The ophthalmologist performing cataract surgery today has a wide variety of options in terms of both surgical technique and available surgical adjuncts, which can greatly enhance the results of cataract surgery. Surgical adjuncts used both preoperatively and intraoperatively include mydriatics, pupil maintainers, oculopressor devices, viscoelastics, and intraocular irrigating solutions. Cataract surgical techniques continue to evolve, and phacoemulsification continues to increase in popularity. Hydrodissection and related techniques have become an important part of all types of extracapsular cataract surgery. In this article, we review cataract surgical techniques and the use of surgical adjuncts with an emphasis on the recent literature. Modifying surgical techniques to incorporate new developments and thus enhance results remains a distinct challenge to the ophthalmic surgeon.