Miotics after modern cataract surgery are history.
OBJECTIVE
The aim of this study was to investigate the usefulness of a long-acting miotic (physostigmine) after phacoemulsification in preventing peripheral anterior synechiae (PAS), lens dislocation, and high postoperative intraocular pressure.


METHODS
This was a prospective randomized controlled trial of 400 patients (400 eyes) scheduled for phacoemulsification. Patients were randomly assigned either to receive a single application of physostigmine ointment directly after phacoemulsification or not. The main outcome measures were the change of intraocular pressure (IOP) before and after surgery, number of extra outpatient clinic visits within 4 weeks postoperatively, verbal rating pain scale (VRS), status of the angle by gonioscopy, and best corrected visual acuity (BCVA).


RESULTS
There was no significant difference in IOP and BCVA between both groups. There were more patients who reported a VRS score of more than 3 in the physostigmine group (P=0.021). PAS or (anterior) lens dislocation was not observed.


CONCLUSIONS
In eyes without co-morbidity, the routine use of physostigmine ointment has lost its rationale.
Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands. m.dieleman@eyehospital.nl
Myrthe
M
Dieleman
René J
RJ
Wubbels
Peter W T
PW
De Waard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D007906:Lens Subluxation / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008916:Miotics / Q000008:administration & dosage / Q000627:therapeutic use*; D009798:Ocular Hypertension / Q000209:etiology / Q000517:prevention & control*; D009824:Ointments; D010147:Pain Measurement; D018918:Phacoemulsification / Q000009:adverse effects* / Q000379:methods; D010830:Physostigmine / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects
D008916:Miotics; D009824:Ointments; D010830:Physostigmine