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Benjamin Katz, Bethany Markowitz; Comparison of cumulative dissipated energy, total phacoemulsification time, and visual acuity in the early post operative period following uncomplicated cataract extraction by resident surgeons with and without the use of intracameral preservative free epinephrine. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1835.
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The stability of the anterior chamber is essential for successful cataract extraction. This is especially important in an institution involved with the teaching and training of surgeons. Early surgical cases often lead to longer operative times and recovery periods. Intracameral epinephrine, which is easily administered and has a low side effect profile, may be used to stabilize the iris and provide mild pupillary dilation. The purpose of this study is to compare surgical outcomes with and without the use of epinephrine to more fully assess its impact.
The surgical operative reports at an academic institution were retrospectively reviewed over a one month period. Cases preformed by a single resident surgeon were then selected and complicated cases such as those involving vitreous loss or posterior capsule tear were excluded. Two groups were then formed, those patients that had received intraoperative intracameral epinephrine (Epi. group) and those that did not (Non-Epi. group). A dilution of 1:1,000 bisulfite-free and preservative-free epinephrine further diluted with BSS to a concentration of 1:4,000 was used. Cumulative dissipated energy (CDE) and total phacoemulsification time (TPT) were recorded along with one day and one week post operative visual acuity (VA).
The Epi. group consisted of 8 eyes from 8 patients. Average TPT was 1:09 min (range of 0:33 - 2:27 min) and average CDE was 20.9 (range of 6.5 - 44.4). VA at one day and one week was 20/162 and 20/33. The Non-Epi. group included 34 eyes from 32 patients. Average TPT was 1:06 (range of 0:24 - 1:58 min) and CDE 15.0 (range of 3.5 - 30.1). One day and one week VA was 20/79 and 20/32. The Epi. group had a 14.3s longer TPT with a p-value of 0.08 and a higher CDE by 5.9, p = 0.04. VA at one day and one week were not significantly different with p-values of 0.07 and 0.45 respectively.
Intracameral epinephrine can be used in difficult cases involving iris instability to produce similar visual outcomes and TPT as routine cases. Although a higher CDE was required in the epinephrine group, one day and one week VA where not significantly changed. This simple intervention can allow the training surgeon to produce consistent results.
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