Tabandeh H, Thompson G M, Kon C, Bolton T
Department of Ophthalmology, St. George's Hospital, London, UK.
Eye (Lond). 1995;9 ( Pt 4):452-5. doi: 10.1038/eye.1995.105.
Following cataract surgery, entrapment of the iris within the surgical wound is often managed by intensive use of miotics. As the radial fibres stretch, only a small amount of fraction is exerted upon the entrapped iris. Application of a combination of phenylephrine and pilocarpine drops causes simultaneous contraction of the pupil sphincter and the radial muscle fibres. This study investigated the relative magnitude of forces induced in the iris periphery by pilocarpine and phenylephrine and the effectiveness of adding g. phenylephrine 10% to g. pilocarpine 4% drops in the treatment of postoperative irido-corneal adhesions. The investigation was divided into two parts. First, the forces induced in the iris periphery upon exposure to pilocarpine and phenylephrine were measured in 6 cadaver irises. The mean force was 27.5 +/- 5.7 x 10(-3) N for pilocarpine and 23.3 +/- 4.0 x 10(-3) N for phenylephrine. The combination of the two drugs produced a force of 54.2 +/- 6.6 x 10(-3) N (p < 0.05). In the second part of the study intensive pilocarpine 4% drops were administered to 17 patients who had iris-wound entrapment on the first post-operative day. Patients with persistent adhesion were commenced on intensive g. phenylephrine 10% and assessed after 90 minutes. Of the 17 patients, 6 responded to pilocarpine drops alone; in a further 7 the irido-corneal adhesion was released only by the addition of phenylephrine drops, and in 4 patients drops were ineffective in relieving the adhesion. This study indicates that addition of phenylephrine 10% to pilocarpine 4% drops enhances the effectiveness of pharmacological treatment of post-operative irido-corneal adhesion.
白内障手术后，虹膜被卡在手术伤口内的情况通常通过大量使用缩瞳剂来处理。随着放射状纤维伸展，只有一小部分力量作用于被卡住的虹膜。应用去氧肾上腺素和毛果芸香碱滴眼液的组合会导致瞳孔括约肌和放射状肌纤维同时收缩。本研究调查了毛果芸香碱和去氧肾上腺素在虹膜周边诱导产生的相对力量大小，以及在4%毛果芸香碱滴眼液中添加10%去氧肾上腺素滴眼液治疗术后虹膜角膜粘连的有效性。该研究分为两部分。首先，在6只尸体眼睛的虹膜上测量暴露于毛果芸香碱和去氧肾上腺素时在虹膜周边诱导产生的力量。毛果芸香碱产生的平均力量为27.5±5.7×10⁻³N，去氧肾上腺素产生的平均力量为23.3±4.0×10⁻³N。两种药物联合产生的力量为54.2±6.6×10⁻³N（p<0.05）。在研究的第二部分，在术后第一天对17例虹膜伤口被卡住的患者给予4%毛果芸香碱滴眼液。粘连持续存在的患者开始使用10%去氧肾上腺素滴眼液，并在90分钟后进行评估。17例患者中，6例仅对毛果芸香碱滴眼液有反应；另外7例患者仅通过添加去氧肾上腺素滴眼液才使虹膜角膜粘连松解，4例患者滴眼液未能有效缓解粘连。本研究表明，在4%毛果芸香碱滴眼液中添加10%去氧肾上腺素可提高术后虹膜角膜粘连药物治疗的有效性。
