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Lundberg, Björn
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Backstrom, G., Lundberg, B. & Behndig, A. (2013). Intracameral acetylcholine effectively contracts pupils after dilatation with intracameral mydriatics. Acta Ophthalmologica, 91(2), 123-126
Open this publication in new window or tab >>Intracameral acetylcholine effectively contracts pupils after dilatation with intracameral mydriatics
2013 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91, no 2, p. 123-126Article in journal (Refereed) Published
Abstract [en]

Purpose: To determine whether intracameral acetylcholine can contract pupils dilated with intracameral mydriatics in phacoemulsification cataract surgery. Methods: A total of 60 patients were included in this prospective randomized masked study performed at ornskoldsviks Hospital Eye Clinic. The patients were randomized and were given either topical placebo and an intracameral mydriatic solution (ICM) (cyclopentolate 0.1%, phenylephrine 1.5% and xylocaine 1%) (n=30) or topical mydriatics (TM) (cyclopentolate 0.85% and phenylephrine 1.5%) and xylocaine 1% intracamerally (n=30) at the start of surgery. After intraocular lens (IOL) implantation, 0.15ml 1% acetylcholine was given intracamerally in all cases. The pupil size was registered preoperatively, 45seconds after intracameral injection, after ophthalmic viscosurgical device (OVD) evacuation, 30seconds after acetylcholine injection, 2min after acetylcholine injection and the day after surgery. Results: The pupil contraction and pupil size after acetylcholine injection showed no significant differences at 30seconds (contraction 1.0 +/- 0.4 in ICM group versus 0.9 +/- 0.4 in TM group; p=0.75; size 4.8 +/- 1.1 in the ICM group versus 5.2 +/- 1.1 in the TM group; p=0.24) or at 2min (contraction 1.5 +/- 0.6 in the ICM group versus 1.4 +/- 0.6 in the TM group; p=0.63; size 4.3 +/- 0.9 in the ICM group versus 4.7 +/- 1.0 in the TM group; p=0.13). No difference in baseline pupil size after ophthalmic viscosurgical device (OVD) evacuation was seen between the two groups (5.8 +/- 0.9 in the ICM group versus 6.1 +/- 1.2 in the TM group; p=0.28). Conclusion: We here show that intracameral acetylcholine contracts pupils as effectively after dilatation with intracameral mydriatics as after dilatation with topical mydriatics. Cataract surgeons can feel comfortable and safe when using intracameral mydriatics, even if pupil contraction with acetylcholine should be required.

Keywords
acetylcholine, cataract, contraction, intracameral, mydriatic, phacoemulsification, pupil
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-67576 (URN)10.1111/j.1755-3768.2011.02376.x (DOI)000315331800012 ()
Available from: 2013-06-04 Created: 2013-03-25 Last updated: 2018-06-08Bibliographically approved
Lundberg, B. & Behndig, A. (2013). Intracameral mydriatics in phacoemulsification cataract surgery - a 6-year follow-up. Acta Ophthalmologica, 91(3), 243-246
Open this publication in new window or tab >>Intracameral mydriatics in phacoemulsification cataract surgery - a 6-year follow-up
2013 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91, no 3, p. 243-246Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate the long-term safety of intracameral mydriatics (ICM) in phacoemulsification cataract surgery compared with conventional topical mydriatics (TM). Methods: A total of 45 patients were examined 6 years after phacoemulsification cataract surgery. The patients had previously participated in a prospective randomized double-blind study including 60 patients, operated with either ICM or TM. The follow-up included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grade of posterior capsule opacification (PCO), YAG laser capsulotomy rate, pupil size, corneal thickness and endothelial morphology. Results: No differences in postoperative BCVA, IOP, pupil size, PCO or YAG rate were observed between the groups. Endothelial cell loss, endothelial morphology and corneal thickness were also equivalent. Conclusions: Intracameral mydriatics is a safe alternative to topical mydriatics in phacoemulsification cataract surgery with no long-term disadvantages at 6-year follow-up.

Keywords
cataract surgery, endothelial cell loss, Intracameral mydriatics, phenylephrine, posterior capsule opacification, pupil dilatation, topical mydriatics
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-71589 (URN)10.1111/j.1755-3768.2011.02378.x (DOI)000317983000029 ()
Available from: 2013-06-05 Created: 2013-06-04 Last updated: 2018-06-08Bibliographically approved
Janbaz, C. C., Lundberg, B. & Behndig, A. (2012). Stimulation of adrenergic β-receptors enhances mydriasis in a porcine eye model. Acta Ophthalmologica, 90(5), 418-421
Open this publication in new window or tab >>Stimulation of adrenergic β-receptors enhances mydriasis in a porcine eye model
2012 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 90, no 5, p. 418-421Article in journal (Refereed) Published
Abstract [en]

Purpose: To compare the mydriatic effect of intracamerally injected isoprenaline plus phenylephrine to phenylephrine alone and to epinephrine in a porcine eye model, aiming to eventually find the best combination of adrenergic substances for surgical mydriasis in humans.

Methods: In this study, we used 89 intact eyes from newly slaughtered pigs, pretreated with 2.0 mg of intracameral acetylcholine. After waiting 60 seconds for miosis to develop, 0.15 ml 0.3% isoprenaline and 0.15 ml 3.0% phenylephrine were injected sequentially with a 90-second interval in 21 eyes. In another 22 eyes, the same substances were given in the reverse order. In 20 eyes, 0.15 ml of 0.025% epinephrine was injected, and as a negative control 0.15 ml of balanced salt solution was injected in 26 eyes. The pupils were filmed during the treatments, and the mean pupil diameters were measured every 15 seconds from the video recordings.

Results: Phenylephrine injected after isoprenaline had a larger mydriatic effect than epinephrine (p < 0.01). Without isoprenaline pretreatment, the mydriatic effect of phenylephrine was significantly smaller than that of epinephrine (p < 0.05). Isoprenaline also exhibited a small mydriatic effect of its own.

Conclusions: The β-receptor stimulator isoprenaline enhances the mydriatic effect of intracameral phenylephrine, indicating a role for the β-receptor in the mydriatic response. Mydriasis mediated by β-receptors may explain why nonspecific adrenergic stimulators such as epinine and epinephrine can have larger mydriatic effects than the specific α(1) -receptor stimulator phenylephrine.

Keywords
epinephrine;intracameral mydriatics;isoprenaline;mydriatics;phenylephrine
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-42599 (URN)10.1111/j.1755-3768.2010.02096.x (DOI)21310013 (PubMedID)
Available from: 2011-04-11 Created: 2011-04-11 Last updated: 2018-06-08Bibliographically approved
Behndig, A. & Lundberg, B. (2010). Mydriatic response to different concentrations of intracameral phenylephrine in humans. Journal of cataract and refractive surgery, 36(10), 1682-1686
Open this publication in new window or tab >>Mydriatic response to different concentrations of intracameral phenylephrine in humans
2010 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 36, no 10, p. 1682-1686Article in journal (Refereed) Published
Abstract [en]

Results show that phenylephrine injected intracamerally does not have a linear mydriatic dose-response relationship in humans. At very high concentrations, phenylephrine may bind to and stimulate receptors other than the α(1)-receptor, explaining this phenomenon.

Keywords
Mydriatic response, phenylephrine
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-42565 (URN)10.1016/j.jcrs.2010.04.036 (DOI)20870113 (PubMedID)
Available from: 2011-04-11 Created: 2011-04-11 Last updated: 2018-06-08Bibliographically approved
Lundberg, B. & Behndig, A. (2009). Preoperative topical cyclopentolate can be omitted when using intracameral lidocaine in phacoemulsification surgery. Acta Ophthalmologica, 87(3), 297-299
Open this publication in new window or tab >>Preoperative topical cyclopentolate can be omitted when using intracameral lidocaine in phacoemulsification surgery
2009 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 87, no 3, p. 297-299Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the mydriatic effect of topical cyclopentolate 1% when combined with topical phenylephrine 10% and intracameral lidocaine 1% in phacoemulsification cataract surgery.

METHODS: We performed a prospective, double-masked, randomized trial including 20 patients with age-related cataract, who were scheduled for unilateral phacoemulsification and intraocular lens (IOL) implantation. Patients were given either two drops of phenylephrine 10% at 30 mins and 15 mins prior to surgery (group 1), or two drops each of cyclopentolate 1% and phenylephrine 10% at the same time points (group 2). All patients were also given lidocaine 1% intracamerally at the beginning of the procedure. Intraoperative pupil sizes were assessed from video-recordings.

RESULTS: Initially, pupil sizes were significantly smaller in group 1 (4.8 +/- 1.2 mm versus 6.5 +/- 1.4 mm; p = 0.0098), but the lidocaine injection increased the pupil sizes in group 1 significantly, so that pupil sizes in both groups were equalized throughout the surgical procedure.

CONCLUSIONS: Preoperative topical cyclopentolate does not enhance mydriasis in phacoemulsification surgery when using intracameral lidocaine and can be omitted when intracameral lidocaine is used.

Keywords
cyclopentolate;intracameral;lidocaine;mydriatics;phenylephrine, phacoemulsification surgery
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-23817 (URN)10.1111/j.1755-3768.2007.01093.x (DOI)19437617 (PubMedID)
Available from: 2009-06-29 Created: 2009-06-29 Last updated: 2018-06-08Bibliographically approved
Lundberg, B. & Behndig, A. B. (2009). The mydriatic effect of intracameral epinine hydrochloride. Investigative Ophthalmology and Visual Science, 50(11), 5336-5338
Open this publication in new window or tab >>The mydriatic effect of intracameral epinine hydrochloride
2009 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 50, no 11, p. 5336-5338Article in journal (Refereed) Published
Abstract [en]

PURPOSE. To compare the mydriatic effect and the short-term corneal endothelial safety of intracamerally injected N-methyl-3,4-dihydroxyphenylamine (epinine) to phenylephrine in a porcine eye model.

METHODS. One hundred and twelve eyes from newly slaughtered pigs were used in this study. After pretreatment with 20 mg of intracameral acetylcholine to give miosis, 0.15 ml of epinine or phenylephrine 0.3%, 1.5% or 3.0% was given as an intracameral injection. The pupils were filmed during 90 seconds with a video camera connected to an operation microscope, and the mean pupil diameters were measured from the video recordings. In 37 additional eyes, 0.15 ml of the vehicle, 1.5% epinine or 1.5% phenylephrine was injected intracamerally, and the eyes were kept on ice overnight. Corneal endothelial morphology was assessed before and after the treatment. Ten eyes were given no injection and served as controls.

RESULTS. Epinine had a significantly larger mydriatic effect than phenylephrine at equal concentrations. The endothelial cell loss was equal with both substances, and did not exceed that of the vehicle.

CONCLUSIONS. Epinine was a more potent mydriatic than phenylephrine in this porcine eye model. The porcine eye model appears suitable as a first efficacy screening of substances for intraocular use. Epinine is a promising candidate substance for intraoperative intracameral use in humans, for example in cataract surgery.

Keywords
phacoemulsification cataract-surgery; congestive heart-failure; ocular pharmacokinetics; ibopamine; pharmacodynamics; phenylephrine; dilation; rabbits
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-23824 (URN)10.1167/iovs.09-3651 (DOI)19474400 (PubMedID)
Available from: 2009-06-29 Created: 2009-06-29 Last updated: 2018-06-08Bibliographically approved
Lundberg, B. (2008). Safety and efficacy of intracameral mydriatics in cataract surgery. (Doctoral dissertation). Umeå: Klinisk vetenskap
Open this publication in new window or tab >>Safety and efficacy of intracameral mydriatics in cataract surgery
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In order to perform cataract surgery, adequate dilatation of the pupil is essential. This is traditionally achieved by preoperative topical mydriatic eye-drops, commonly cyclopentolate and phenylephrine. This routine has several disadvantages. First, the slow penetration through the cornea delays the onset of mydriasis. Second, the limited bioavailability of topically administered substances with significant systemic absorption may increase the risk for systemic side effects. Third, even if good mydriasis is achieved initially with topical mydriatics (TM), the effect tends to wear off during surgery. In relation to cataract surgery a transient postoperative corneal oedema is sometimes noted, indicating effects on the corneal endothelial pump function. These effects have been ascribed to ultrasonic or mechanical trauma from the phacoemulsification procedure. Corneal endothelial cell loss (ECL) is a commonly studied variable, not least because it is associated with the long-term risk for corneal decompensation. But, there has been a debate whether postoperative corneal swelling after phacoemulsification cataract surgery correlates to ECL.

Aims: To evaluate an alternative mydriatic regimen for phacoemulsification cataract surgery: intracameral injection of mydriatics mixed with lidocaine (ICM). Additionally, to determine the correlation between early transient postoperative corneal oedema and permanent ECL after phacoemulsification cataract surgery.

Methods: Pupil dilatation with ICM (150 µl of lidocaine 1%, phenylephrine 1.5%, and cyclopentolate 0.1%) was compared to TM (phenylephrine 10% and cyclopentolate 1%) prior to cataract surgery. Additionally, two ICM-groups were randomized to receive either 0.6 µg/ml epinephrine added to the irrigating balanced salt solution or no epinephrine in the irrigation solution. Furthermore, two randomized ICM-groups, with or without cyclopentolate, were analyzed. The patients planned for cataract surgery were examined with ultrasonic pachymetry, specular microscope endothelial photography and Orbscan II slit-scan tomography pre- and postoperatively.

Results: With ICM, mydriasis reached 95 ± 3% of its final value within 20 seconds. In the ICM-group, the pupils were smaller than in the TM-group (mean 6.7 ± 1.0 mm versus 7.7 ± 1.0 mm, P<.001), but did not contract intraoperatively as the TM pupils did. Conversely, with ICM the pupil sizes generally increased during the cataract procedures. This increase was significantly greater without epinephrine in the irrigating solution (13 ± 19% versus 4 ± 14%; p = 0.02). No significant differences in pupil sizes were observed between the patients who were given ICM with or without cyclopentolate. The central corneal swelling at the first postoperative day was strongly correlated to the central ECL at 3 months, R2 = 0.785, P < 0.001.

Conclusions: ICM is a rapid and safe alternative to TM in phacoemulsification cataract surgery. An irrigating solution without epinephrine can safely be used with ICM. Cyclopentolate, administrated intracamerally, has no immediate additive mydriatic effect to intracameral lidocaine combined with phenylephrine. The degree of permanent corneal endothelial damage in cataract surgery is reflected in the degree of early postoperative corneal swelling.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap, 2008. p. 88
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1146
Keywords
Ophtalmology, intracameral, mydriatics, pupil, cataract, phacoemulsification, lidocaine, phenylephrine, cyclopentolate, epinephrine, endothelial cell loss, Oftalmiatrik
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-1486 (URN)978-91-7264-470-0 (ISBN)
Public defence
2008-02-01, Sal B, 1D, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2018-06-09Bibliographically approved
Lundberg, B. & Behndig, A. (2007). Intracameral mydriatics in phacoemulsification surgery obviate the need for epinephrine irrigation.. Acta Ophthalmologica Scandinavica, 85(5), 546-550
Open this publication in new window or tab >>Intracameral mydriatics in phacoemulsification surgery obviate the need for epinephrine irrigation.
2007 (English)In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, no 5, p. 546-550Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the possibility of removing epinephrine from the irrigating solution in phacoemulsification surgery when using intracameral mydriatics (ICMs). METHODS: We carried out a prospective, randomized, double-blinded study of 140 patients with age-related cataracts, scheduled for unilateral phacoemulsification. The first part of the study involved 90 patients divided into two groups. Patients in both groups were given 150 microl ICMs at the beginning of the procedure. In group 1, 0.6 microg/ml epinephrine was added to the irrigating balanced salt solution. No epinephrine was added to the irrigation solution used in group 2. The second part of the study involved 50 patients, all of whom were given topical mydriatics (TMs) and then similarly divided into two groups and treated as in the first study setting. RESULTS: With ICMs, pupil sizes generally increased during the procedures. Remarkably, this increase was significantly greater without epinephrine (13 +/- 19% versus 4 +/- 14%; p = 0.02). In the TMs setting, pupil sizes decreased intraoperatively in both groups; significantly more without epinephrine (- 5 +/- 4% versus - 12 +/- 7%; p < 0.001). CONCLUSIONS: An irrigating solution without epinephrine can safely be used with ICMs. The increase in pupil size during the procedure is greater without epinephrine. This study also confirms earlier findings that epinephrine is beneficial when using TMs.

Keywords
phacoemulsification, epinephrine, intracameral mydriatics
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-22320 (URN)10.1111/j.1600-0420.2007.00892.x (DOI)17324218 (PubMedID)744 (Local ID)744 (Archive number)744 (OAI)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2018-06-08
Johansson, M., Lundberg, B. & Behndig, A. (2007). Optical coherence tomography evaluation of macular edema after phacoemulsification surgery with intracameral mydriatics.. Journal of cataract and refractive surgery, 33(8), 1436-41
Open this publication in new window or tab >>Optical coherence tomography evaluation of macular edema after phacoemulsification surgery with intracameral mydriatics.
2007 (English)In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 33, no 8, p. 1436-41Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To quantify the macular edema induced by intracameral mydriatics in phacoemulsification surgery. SETTING: University hospital eye clinic, Umeå, Sweden. METHODS: In a randomized study of 22 patients, 11 patients were given 150 muL of a mixture of phenylephrine 1.5% and lidocaine 1% intracamerally for mydriasis and anesthesia. In a control group (n = 11), conventional topical mydriatics and intracameral lidocaine were given. Multiple preoperative, intraoperative, and postoperative variables were recorded. RESULTS: There were no differences in macular edema between the 2 treatments. A correlation was seen between macular edema and impaired visual acuity 1 week postoperatively. On the first postoperative day, a similar correlation was seen between corneal edema and the degree of visual improvement. CONCLUSIONS: Intracameral lidocaine and phenylephrine for mydriasis and anesthesia did not induce more significant macular edema than the standard regimen of topical mydriatics plus intracameral lidocaine. Macular edema limited visual improvement 1 week after phacoemulsification, while corneal edema appeared to have a larger effect immediately after surgery.

Identifiers
urn:nbn:se:umu:diva-20984 (URN)10.1016/j.jcrs.2007.04.027 (DOI)17662438 (PubMedID)
Available from: 2009-03-31 Created: 2009-03-31 Last updated: 2018-06-09
Lundberg, B., Jonsson, M. & Behndig, A. (2005). Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery.. American Journal of Ophthalmology, 139(6), 1035-1041
Open this publication in new window or tab >>Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery.
2005 (English)In: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 139, no 6, p. 1035-1041Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate postoperative corneal swelling as a predictor of corneal endothelial cell loss after phacoemulsification cataract surgery. DESIGN: Prospective observational case series. METHODS: Thirty patients planned for routine phacoemulsification cataract surgery were included. Ultrasonic pachymetry and specular microscope endothelial photography of the central and nasal portions of the cornea and Orbscan II slit-scan tomography were performed preoperatively and the day after surgery. The 30 patients were selected from 41 patients based on their increase in central corneal thickness: the first 10 cases with a <5% increase, the first 10 with a 6% to 20% increase, and the first 10 with a > or =20% increase. The same measurements were repeated after 1, 2, and 3 months. The primary outcome measures were corneal endothelial cell loss and increase in pachymetry. Several other parameters were also registered, including age, degree of cataract, visual acuity, phacoemulsification time and energy, total operation time, and the amount of infusion fluid used. RESULTS: The central corneal swelling at postoperative day 1 was strongly correlated with the central corneal endothelial cell loss at 3 months (R(2) = 0.785, P < .001). CONCLUSIONS: In this series, with large variations in the corneal swelling at the first postoperative day, the degree of permanent corneal endothelial damage was reflected in the degree of early postoperative corneal swelling. Measuring the difference in pachymetry at postoperative day 1 is a useful way to assess the effects on the corneal endothelium exerted by the phacoemulsification procedure.

Keywords
corneal swelling, phacoemulsification, cataract surgery
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-22319 (URN)10.1016/j.ajo.2004.12.080 (DOI)15953433 (PubMedID)744 (Local ID)744 (Archive number)744 (OAI)
Available from: 2009-05-05 Created: 2009-05-05 Last updated: 2018-06-08
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