Intracameral medication use requires careful consideration of pros and cons

When thinking about administering medications intracamerally during cataract surgery, it is important to consider whether their potential benefits are worth the risk, said Nick Mamalis, MD, at Spotlight on Cataracts 2007.

Intracameral medications may be used in cataract surgery for anesthesia, pupil dilation, and to prevent inflammation and endophthalmitis. Their advantages include ease of delivery, elimination of toxicity of topical drops, avoidance of compliance issues, and possibly enhanced efficacy.

However, there are a number of downsides. Toxicity is an important risk that can occur through multiple mechanisms, which can be related to improper concentration, pH, or osmolarity. In addition, all medications used intracamerally should be preservative-free, but it is also important to be aware of toxicity related to stabilizing agents, such as are found in preservative-free epinephrine. Infectious contamination is another safety concern as is the potential for incompatibility when multiple drugs are combined.

"There are many trade-offs to consider when weighing the pros and cons of using topical drops versus intracameral medications. Intracameral medication safety can be improved if we could eliminate 'kitchen pharmacy,'" Dr. Mamalis said.

"We need sterile, pre-mixed, preservative-free, unit-dose products, and the ophthalmology community needs to work with the FDA and industry to achieve that goal," he added.