Surgical pharmacology has played a key role in safety of cataract surgery

BOSTON — The science of surgical pharmacology in ophthalmology was born of a need to better understand the many adjuncts that surgeons use in removing cataracts and, in the future, will continue to identify potential drug-induced toxicities, according to a speaker here.

Henry F. Edelhauser

"Surgical pharmacology will continue to evolve in parallel with newly developed surgical techniques and retinal drug treatments," Henry F. Edelhauser, PhD, said during the Charles D. Kelman Innovator's Lecture delivered at the annual meeting of the American Society of Cataract and Refractive Surgery.

In the early days of phacoemulsification, concern over the long-term consequences of the initial corneal edema led to the development of intraocular irrigating solutions. Early pharmacological experiments helped define the utility of balanced salt solution in phaco surgery. Later researchers working in this area identified the addition of hydroxypropyl methylcellulose to lower surface tension of the solution, thus minimizing turbulence while effectively preserving the mucin layer coating the endothelial cell layer, Dr. Edelhauser said.

As phaco surgery technology continued to advance, pharmacological research helped explain the interaction of intraocular tissues with the many drugs and solutions used during surgery. These studies helped to identify the gold standard for mydriasis, lid scrubs, topical anesthetics, irrigation and its additives, and postoperative medications.

"As new techniques are developed and new drugs are used, there is a need to be aware of effectiveness, toxicity and reproducibility," Dr. Edelhauser said.

In the future, the principles and theories used in understanding cellular interaction with these solutions through pharmacological research may help in the creation of novel, minimally invasive drug delivery devices and modalities, Dr. Edelhauser said.

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