Ophthalmologic irrigation solutions and method

Abstract

Solutions for perioperative intraocular application by continuous irrigation during ophthalmologic procedures are provided. These solutions include multiple agents that act to inhibit inflammation, inhibit pain, effect mydriasis (dilation of the pupil), and/or decrease intraocular pressure, wherein the multiple agents are selected to target multiple molecular targets to achieve multiple differing physiologic functions, and are included in dilute concentrations in a balanced salt solution carrier.

Claims

1. A method for promoting mydriasis during an intraocular ophthalmologic procedure, comprising intraocular application of a solution comprising a local anesthetic agent combined with a mydriatic agent that is an alpha-1 adrenergic receptor agonist in a physiologic carrier, wherein the agents are included in therapeutically effective amounts for mydriasis during the procedure when delivered intraocularly.

2. The method of claim 1, wherein the local anesthetic agent is selected from the group consisting of lidocaine, tetracaine, bupivacaine, and proparacaine.

3. The method of claim 1, wherein the alpha-1 adrenergic receptor agonist is selected from the group consisting of phenylephrine, epinephrine and oxymetazoline.

4. The method of claim 1, wherein the alpha-1 adrenergic receptor agonist is selected from the group consisting of phenylephrine and epinephrine.

5. The method of claim 4, wherein the local anesthetic agent is selected from the group consisting of lidocaine, tetracaine, bupivacaine, and proparacaine.

6. The method of claim 1, wherein the solution is applied in a liquid irrigation carrier.

7. The method of claim 6, wherein the solution is applied by intraocular irrigation.

8. The method of claim 6, wherein the liquid irrigation carrier further comprises electrolytes sufficient to provide a physiological balanced salt solution.

9. The method of claim 1, wherein the solution is continuously applied to the intraocular tissues during the intraocular procedure.

10. The method of claim 1, wherein the solution further comprises a non-steroidal anti-inflammatory drug (NSAID).

11. The method of claim 1, wherein the alpha-1 adrenergic receptor agonist is included in the solution at a concentration of no more than 1,000,000 nanomolar and the local anesthetic agent is included in the solution at a concentration of no more than 100,000,000 nanomolar.

Description

VII. Examples

(1) The following are exemplary formulations in accordance with the present invention suitable for ophthalmologic procedures.

Example 1

(2) Exemplary ophthalmologic solutions of the present invention for use during cataract removal surgery are described in Tables 20, 21 and 22. This solution, and the following solutions of Tables 23-25, are provided by way of example only, and are not intended to limit the invention. Anti-inflammatories are believed to be particularly useful in cataract solutions of the invention, to potentially reduce the post-operative incidence of, or hasten resolution of, cystoid macular edema (CME). These exemplary solutions and the other exemplary ophthalmologic irrigation solutions described herein below are provided in terms of the concentration of each agent included in the previously described preferred balanced-salt solution. The solution may suitably be supplied in 500 ml bags, this being the quantity of irrigation solution typically applied during a procedure, by way of non-limiting example.

(3) TABLE-US-00020 TABLE 20 Exemplary Cataract Solution Concentration Class of (Nanomolar): Most Agent Drug Therapeutic Preferred Preferred anti- flurbiprofen 10-1,000,000 100-100,000 1,000-10,000 inflamma- tory IOP red. timolol 10-1,000,000 100-100,000 1,000-10,000 agent mydriatic phenylephrine 50-500,000 500-100,000 1,000-10,000

(4) TABLE-US-00021 TABLE 21 Alternate Exemplary Cataract Solution Concentration Class of (Nanomolar): Most Agent Drug Therapeutic Preferred Preferred anti- ketoprofen 10-1,000,000 100-100,000 1,000-10,000 inflamma- tory IOP red. timolol 10-1,000,000 100-100,000 1,000-10,000 agent mydriatic tropicamide 10-1,000,000 100-100,000 1,000-10,000

(5) TABLE-US-00022 TABLE 22 Alternate Exemplary Cataract Solution Concentration Class of (Nanomolar): Most Agent Drug Therapeutic Preferred Preferred mydriatic, oxy- 10-1,000,000 100-100,000 1,000-10,000 IOP red. metazoline agent anti- flurbiprofen 10-1,000,000 100-100,000 1,000-10,000 inflammtory

Example 2

(6) A similar irrigation solution including multiple agents for effective reduction of inflammation and to provide mydriasis for invasive ophthalmologic surgery, such as a trabeculectomy, is provided in Table 23.

(7) TABLE-US-00023 TABLE 23 Exemplary Trabeculectomy Solution Concentration Class of (Nanomolar): Most Agent Drug Therapeutic Preferred Preferred anti- prednisolone 10-1,000,000 100-100,000 1,000-10,000 inflamma- tory anti- flurbiprofen 10-1,000,000 100-100,000 1,000-10,000 inflamma- tory IOP red. timolol 10-1,000,000 100-100,000 1,000-10,000 agent mydriatic phenylephrine 50-500,000 500-100,000 1,000-10,000

Example 3

(8) Irrigation solutions suitably used for extensive ophthalmologic surgery or posterior ocular chamber procedures, such as vitrectomy, provide increased analgesia by the addition of a local anesthetic. Such solutions of the present invention including a local anesthetic are provided in Tables 24 and 25.

(9) TABLE-US-00024 TABLE 24 Exemplary Local Anesthetic Ophthalmologic Solution Concentration (Nanomolar): Most Class of Agent Drug Therapeutic Preferred Preferred IOP red. agent timolol 10-1,000,000 100-100,000 1,000-10,000 anti- flurbiprofen 10-1,000,000 100-100,000 1,000-10,000 inflammatory mydriatic tropicamide 10-1,000,000 100-100,000 1,000-10,000 analgesic lidocaine 1,000-100,000,000 10,000-10,000,000 100,000-1,000,000

(10) TABLE-US-00025 TABLE 25 Alternate Exemplary Local Anesthetic Ophthalmologic Solution Concentration (Nanomolar): Most Class of Agent Drug Therapeutic Preferred Preferred IOP red. agent timolol 10-1,000,000 100-100,000 1,000-10,000 anti- flurbiprofen 10-1,000,000 100-100,000 1,000-10,000 inflammatory mydriatic tropicamide 10-1,000,000 100-100,000 1,000-10,000 analgesic bupivacaine 125-400,000 1,000-300,000 225,000-275,000

(11) While the preferred embodiment of the invention has been illustrated and described, it will be appreciated that various changes to the disclosed solutions and methods can be made therein without departing from the spirit and scope of the invention. For example, alternate pain inhibitors, inflammation inhibitors, IOP reducing agents and mydriatic agents may be discovered that may augment or replace the disclosed agents in accordance with the disclosure contained herein. It is therefore intended that the scope of letters patent granted hereon be limited only by the definitions of the appended claims.