Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0086543 (cataract)
 29,165 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Topically applied drugs are an important part of the pharmacologic management of cataract extraction and lens implant surgery. Acetylcholine facilitates this procedure via its miotic effect on the ciliary body of the eye. Systemic effects can occur with topically administered ophthalmic medications. Acetylcholine has been implicated in several cases of systemic cholinergic effects, such as hypotension, bradycardia, and bronchospasm, following intraocular administration. The patients we present experienced profound hypotension and bradycardia occurring up to 45 minutes after intraocular injection of acetylcholine. Both patients were over 90 years of age and had a history of first-degree atrioventricular block. As cataract surgery and lens implantation become more prevalent in the older ambulatory segment of the geriatric population, healthcare professionals should be aware that these patients may be more sensitive to the pharmacologic effects of medication used during surgery. Monitoring for adverse effects must be performed intraoperatively and several hours postoperatively. Additionally, patients with known conduction abnormalities prior to surgery should be monitored closely and proper emergency equipment and personnel should be available. Pharmacists who investigate adverse drug reactions should consider ophthalmic medications as potential causes for unexplained or suspected adverse drug reactions.
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PMID:Hypotension and bradycardia possibly associated with intraocular injection of acetylcholine. 176 31

Preoperative treatment with topical nonsteroidal anti-inflammatory agents such as flurbiprofen (Ocufen) is used to maintain pupil dilation during cataract surgery. Flurbiprofen maintains pupil dilatation by inhibiting release of prostaglandins and other modulators of surgical miosis. Some reports suggest that these agents may reduce the miotic effect of intra-operative acetylcholine (Miochol). It is hard to explain this effect unless there is a pharmacological interaction between the two drugs. This study aimed to investigate the possibility of a direct interface by flurbiprofen with the action of acetylcholine on the pupil sphincter. Iris tissue of seven cadaver eyes were isolated and maintained in an organ bath containing Kreb's solution. Pupil contraction force induced by acetylcholine was measured in the presence and absence of flurbiprofen. Acetylcholine produced a mean pupillary contraction force of 52.4 x 10(-3) N. When it was added to the organ bath in the presence of flurbiprofen the mean contraction force was 50.5 x 10(-3) N (paired t-test P = 0.68). This study does not find any evidence to suggest that flurbiprofen reduces the pupil sphincter contraction that is induced by acetylcholine. It is likely that the apparent reduction in miosis is due to factors other than the mechanism of action of acetylcholine on the sphincter pupillae.
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PMID:Effect of flurbiprofen on acetylcholine-induced pupillary contraction. 884 86