|Year : 1988 | Volume
| Issue : 1 | Page : 10-11
Carbachol as miotic agent in intra-ocular lens implant surgery
Cook's Compound Ghasiari Mandi, Lucknow-226001, India
Cook's Compound Ghasiari Mandi, Lucknow-226001
Source of Support: None, Conflict of Interest: None
The intra cameral use of 0.025% carbachol as a miotic agent in anterior chamber intraocular lens implant surgery us reported in 15 cases. Carbachol produced prompt and effective moisis and was found to be harmless and non-irritating to the anterior chamber structures. A rebound dialatation of the pipit was noticed in the post operative period in 3 of our first 5 cases where only carbachol was used. For prolonged miosis instillation of a more powerful miotic like pilocarpine is recommended at the completion of surgery:
|How to cite this article:|
Agarwal J. Carbachol as miotic agent in intra-ocular lens implant surgery. Indian J Ophthalmol 1988;36:10-1
| Introduction|| |
Prompt miosis of the pupil after removal of the lens in anterior chamber intraocular lens implant surgery is mandatory. The most commonly used drug for this purpose has been Acetylcholine but its disadvantages have been its short duration of action and instability in solution.
Carbachol a topical miotic agent has not been widely used in India. Unlike acteyl Cholin it is cheap and easily available. Carbachol is a synthetic choline derivative carbamyl choline chloride, which differs from acetyl choline in that a carbamyl group replaces the acetyl group as shown in [Figure 1].
Carbachol by its direct action on the motor end plate and the carbamyl group with its inhibition of choline esterase has a dual action .
The purpose of this study was to record the miotic effect of intracameral carbachol in anterior chamber lens implant surgery any signs of irritation or post-operative reaction.
| Material and Methods|| |
Carbachol in 0.025% solution has been used as a miotic agent in 15 patients undergoing intraocular lens implant surgery. The age of the patients ranged from 12 years to 62 years. 12 patients had senile cataract while a child of 12 years was having traumatic cataract and in a girl aged 16 years, secondary implantation was done after a 2 years needling and aspiration [Table - 1].
Anterior chamber intraocular lens were implanted under local anaesthesia in all cases. After the removal of the lens approximately 0.5 ml of 0.025% carbachol was injected in the anterior chamber with the help of a fine canula. The vertical and horizontal diameters of the pupil were measured before and after injection of carbachol.
In the first 5 cases (group 1) only carbachol was used while in the next 10 cases (group 11) pilocarpine 2% drops were also instilled after closure of the wound All the cases were examined daily with the slit lamp in the post-operative period for any reaction.
| Results|| |
Carbachol when injected in the anterior chamber after removal of the lens produced a rapid and profound miosis in all 15 cases [Table - 2]. The mean value of pipil size at zero time was 6.0 mm (± 0.82), at one minute it was 2.5 mm (± 0.6) and at two minutes it was 2.2 mm (± 0.44). The change in the pupillary size at zero time compared to the one and two minute times was statistically significant (P=0.01).
In group L 3 cases showed rebound dilation of pupil post operatively 24 hours leading to pseudophakic pupillary block and shallow anterior chamber in these cases. This was managed accordingly. In the Group II, where pilocarpine 2% eye drops were also instilled in the conjunctival sac at the end of surgery, this phenomenon of rebound dilatation was not seen and the pupil remained constricted in the post operative period.
Mild iridocyclitis in one and striate keratitis in another case was noticed on the 3rd post operative day which resolved after treatment [Table - 3].
| Discussion|| |
Although the use of carbachol as a topical miotic agent in ophthalmology is not new its intra-cameral use in intraocular lens implant surgery is yet to be established.
The results and-our clinical impression suggest that carbachol is an effective agent for producing rapid miosis during anterior chamber intraocular lens implant surgery, but its action should be supplemented by topical pilocarpine drops at the end of surgery for obtaining prolonged miosis.
The transitory or persistant comeal oedema in the post operative phase reported after the intracameral use of carbachol  was not seen in any of our cases. Mild iridocyclitis and striate keratitis seen in 2 cases should not be attributed to carbachol.
| References|| |
Beasley, K, et al. : Carbachol in Cataract surgery. Arch Ophthalmol. 80, 39, 1968
Fraunfelder, F.T.: Corneal oedema after use of carbacho]. Arch Ophthalmol, 97, 975, 1979.
[Table - 1], [Table - 2], [Table - 3]