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J Ocul Pharmacol Ther. 2012 Apr;28(2):98-101. doi: 10.1089/jop.2011.0077. Epub 2011 Oct 26.

Miotics after modern cataract surgery are history.

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  • 1Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.



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.


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).


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.


In eyes without co-morbidity, the routine use of physostigmine ointment has lost its rationale.

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