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J. M. Ramocki; Can the Use of Intracameral Epinephrine Reduce the Incidence of Vitreous Loss in Supervised Resident Cataract Surgery in Patients on BPH Medications?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2903.
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Cataract surgery in patients on BPH medications poses a significantly higher risk of vitreous loss. Intracameral epinephrine is becoming more popular for use in intraoperative floppy iris syndrome having ability to achieve mydriasis, reverse miosis, and stiffening the floppiness of the iris. The purpose was to determine if the use of intracameral epinephrine in cataract surgery in patients treated with BPH medications can reduce the incidence of vitreous loss.
377 male patient consecutive resident supervised cataract operations from 11-30-2007 to 11-21-2008 were retrospectively reviewed for incidence of vitreous loss, use of Terazosin or Tamsulosin, and the use of intracameral epinephrine when patients had a history of BPH medication use.
105 of 377 male patients were taking BPH medications (28% prevalence). 61 of 105 patients on BPH medications received intracameral epinephrine during their surgery (58%) with 5 patients incurring vitreous loss (8.2%). 44 of 105 patients on BPH medications did not receive intracameral epinephrine during their surgery (42%) with 8 patients incurring vitreous loss (19%). All patients on BPH medications (105) were known by the surgeons to be on these BPH medications with incidence of 12.4% vitreous loss compared to the 272 patients on no BPH medications among whom 26 patients incurred vitreous loss for an incidence of 9.6% vitreous loss.
Cataract surgery on patients receiving BPH medications poses a higher risk for vitreous loss and other complications. The use of intracameral epinephrine is one of many alternatives in the treatment of IFIS effective in creating mydriasis, reversal of miosis, and stiffening a floppy iris but relatively unstudied in its efficacy and used only by a low percentage of American surgeons as of recent polls. In this study, intracameral epinephrine use on patients undergoing cataract surgery previously treated with BPH medications had less vitreous loss (incidence of only 8.2%) compared to BPH patients that were not given intracameral epinephrine at the time of their surgery (vitreous loss of 19%).
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