Pilocarpine 1% for Improved Near Vision in Pseudophakic Patients.

Purpose: To evaluate the efficacy and safety of 1% pilocarpine to enhance near vision in pseudophakic patients with monofocal intraocular lens (IOL).

Methods: This prospective, nonrandomized, open-label, pre-post interventional study was conducted on patients who had a history of phacoemulsification and monofocal IOL implantation without any complications at least six months before the intervention. One drop of 1% pilocarpine solution was instilled in one of the patients' eyes, and near and distance visual acuity was assessed before and 20 minutes after monocular administration of the drop. Adverse effects were monitored for 8 hours.

Results: We studied54 pseudophakic eyes of 54 patients with a mean age of 55.02 $\pm$ 10.10 years, including 36 males (66.7%). Distance-corrected near visual acuity improved significantly after administering 1% pilocarpine (P $<$ 0.001). After treatment, no significant decrease in corrected distance visual acuity (CDVA) was observed (P = 0.60). Overall, 46 patients (85.2%) exhibited an improvement of more than one line in near vision after treatment; however, eight patients (14.8%) did not show any changes in near vision. Only two patients (3.7%) gained three lines in near vision. Headache, irritation, and nausea were observed in three patients, two patients, and one patient, respectively.

Conclusion: The monocular 1% pilocarpine solution significantly improved near visual acuity among patients with pseudophakia and featured an acceptable safety profile. Although this improvement is considerable, it may not be sufficient for complete spectacle independence. Trial registration: ClinicalTrials.gov identifier: NCT05578001.