From the Department of Anaesthesia, Liverpool Hospital, Liverpool, Australia (Chua); East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom (Varshney); Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom (Eke).
J Cataract Refract Surg. 2024 Feb 1;50(2):187-194. doi: 10.1097/j.jcrs.0000000000001319.
Phenylephrine, a potent sympathomimetic, induces mydriasis via iris dilator muscle contraction. Intracameral (IC) phenylephrine has been successfully used in cataract surgery for initial mydriasis, maintaining mydriasis, and management of intraoperative floppy-iris syndrome. Serious systemic adverse events (mainly cardiovascular) have been described with topical phenylephrine drops, but we found very little evidence of such adverse events associated with IC phenylephrine use. However, we suspect under-reporting of such adverse events, as they may instead be ascribed to anxiety, positioning, anesthesia, etc. Optimal dosage/concentrations for IC phenylephrine use in different purposes have not been fully studied. In the absence of robust evidence, we suggest that lower but effective IC phenylephrine concentrations are used: a lower concentration (0.31%), in conjunction with an anticholinergic and lidocaine, may be used for initial mydriasis. For management of intraoperative floppy-iris syndrome, 0.31% may be effective, though a higher concentration (1% to 1.25%) may be required.
苯肾上腺素是一种强效的拟交感神经药物，通过虹膜扩张肌收缩引起散瞳。房内（IC）苯肾上腺素已成功用于白内障手术中的初始散瞳、维持散瞳和术中软核综合征的管理。局部使用苯肾上腺素滴眼剂会引起严重的全身不良事件（主要是心血管事件），但我们发现与 IC 苯肾上腺素使用相关的此类不良事件的证据非常少。然而，我们怀疑这些不良事件的报告不足，因为它们可能被归因于焦虑、体位、麻醉等。IC 苯肾上腺素用于不同目的的最佳剂量/浓度尚未得到充分研究。在缺乏强有力证据的情况下，我们建议使用较低但有效的 IC 苯肾上腺素浓度：较低浓度（0.31%）与抗胆碱能药物和利多卡因联合使用，可用于初始散瞳。对于术中软核综合征的管理，0.31%可能有效，但可能需要更高浓度（1%至 1.25%）。
