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Presence of free radicals in intracameral agents commonly used during cataract surgery
  1. David Lockington1,
  2. Elisabeth C A Macdonald1,
  3. David Young2,
  4. Philip Stewart3,
  5. Muriel Caslake3,
  6. Kanna Ramaesh1
  1. 1Tennent Institute of Ophthalmology, UK
  2. 2Department of Statistics and Modelling Science, University of Strathclyde, UK
  3. 3Division of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, UK
  1. Correspondence to Dr David Lockington, Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK; davidlockington{at}


Background Free radicals are known to cause cellular damage and are present in ophthalmic preparations. Corneal defence mechanisms are bypassed in intra-ocular surgery. We evaluated commonly used intracameral agents to ascertain the presence of free radicals and investigate the possibility of anterior segment and endothelial toxicity.

Methods Samples of 19 commonly used intracameral preparations were analysed for total free radical presence on an Instrument Laboratory IL600 using a Randox Kit for Total Antioxidant Status (RANDOX Laboratories Ltd, Crumlin, UK).

Results Free radical concentrations for the 19 intracameral agents ranged from 0 to 3.59 mmol/l, with median value of 0.34 mmol/l (mean value 0.933±1.19 mmol/l). Phenylephrine had the highest presence of free radicals, which were considerably higher than those for 0.5% hydrogen peroxide at all tested dilutions. Other notable results included cefuroxime (0.61 mmol/l), 2% undiluted lidocaine (0.34 mmol/l) and bevacizumab (0.59 mmol/l).

Conclusion The results indicate that free radicals are present in intracameral surgical agents and some are in the order of 0.5% hydrogen peroxide. The risks of endothelial damage must be considered when using multiple intracameral preparations in complicated cataract surgery. Free radicals in intracameral preparations may be a contributing cause in cases of toxic anterior segment syndrome.

  • Free radicals
  • intracameral
  • cataract surgery
  • TASS

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.