Putting medication directly into the anterior segment of the eye can be very effective. There are many different medications that we can use during surgery to assist in the procedure or help with post-operative healing.
There are a few important caveats that we must observe before injecting intra-cameral medications. We prefer medications which are specifically designed to be delivered via this route. These medications are sterile, preservative-free, pH-balanced, and safe for contact with delicate ocular structures such as the corneal endothelium and the retina.
There have been reported cases of severe problems associated with certain medications such as hemorrhagic occlusive retinal vasculitis (HORV) which happens rarely with vancomycin use. Other surgeons have experienced dozens of patients with vision loss due to improperly compounded medications. Ultimately, the surgeon should weigh the risks versus benefits and decide what is best for the patient.
Some of the more commonly used medications are:
- anesthetics:
- lidocaine (preservative-free)
- anesthetics are usually dilated with balanced salt solution
- I often use a mixture of 0.5 cc of 2% lidocaine (preservative-free) with 0.5 cc of balanced salt solution. Then this new mixture is 1 cc of 1% lidocaine of which half is injected into the anterior chamber and half is squirted on the cornea.
- mydriatics to dilate the pupil:
- phenylephrine mixtures
- epinephrine mixtures
- miotics to constrict the pupil:
- acetylcholine (Miochol-E)
- carbachol (Miostat)
- antibiotics as prophylaxis against endophthalmitis:
- moxifloxacin
- cefuroxime (such as in the ESCRS endophthalmitis study)
- anti-inflammatories to quell inflammation
- triamcinolone
- certain NSAID mixtures
- Combination Mixtures:
- Epi-Shugarcaine is an eponymous mixture of balanced salt solution, lidocaine and epinephrine proposed by the late Joel Shugar MD.
- ” The recipe in whole cc quantities is: 9 cc BSS Plus 3 cc 4% preservative-free lidocaine and 4 cc 1:1000 preservative-free, bisulfite free epinephrine. Plain BSS may be safely substituted for the BSS Plus. This ends up as buffered 0.75% lidocaine and 1:4000 epinephrine.”
- Epi-Shugarcaine is an eponymous mixture of balanced salt solution, lidocaine and epinephrine proposed by the late Joel Shugar MD.
Click below for intra-cameral medications used during cataract surgery:
