Comparison of intraocular acetylcholine and carbachol

Commercially available 1% acetylcholine chloride and 0.01% carbachol chloride, which are commonly used as miotics in intraocular surgery, have recently been reformulated. Comparative studies of these agents show similar miotic activity. However, in vitro perfusion of human corneas demonstrated that 1% acetylcholine chloride causes marked changes in endothelial function and ultrastructure as compared to carbachol or BSS Plus. This study showed that 0.01% carbachol chloride was less toxic to the corneal endothelium than 1% acetylcholine chloride and suggests that 1% acetylcholine should not be used in corneas with compromised endothelium as in primary corneal endotheliopathies.