Pharmacologic interventions for mydriasis in cataract surgery

Iftikhar, Mustafa; Abariga, Samuel A; Hawkins, Barbara S.; Zafar, Sidra; Mir, Tahreem A.; Jampel, Henry D.; Woreta, Fasika A.

doi:10.1002/14651858.cd012830.pub2

Cited by 6 publications

(4 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The possible explanation of increased anterior chamber reaction in 1 st post-operative day might be due to minimization of cycloplgic might cause micro twitching of iris resulting in dispersion of iris pigments. Our finding corroborates with findings of Iftikhar M et al (2021) 1 who mentioned in their review article about increased incidence of Iris-related complications (11 out of 30 eyes) in intracameral use of Phenylephrine without use of any cycloplegic.…”

Section: Discussionsupporting

confidence: 93%

Pre-operative minimal-cycloplegia mydriasis for capsulorrhexis in hypermature intumescent cataract

Roy

Ganguli²,

Tripathi³

2023

IJCEO

View full text Add to dashboard Cite

Conventionally adrenergic-anticholinergic combination eye drops (e.g., phenylephrine-tropicamide) are used for pre-operative pupillary dilatation in cataract surgery. This achieves synergy in dilatation, but anticholinergic-induced cycloplegia makes already tense lens-capsule of intumescent cataract more taut, and completion of capsulorrhexis becomes difficult, often resulting in Argentanian flag sign, peripheral extension. An alternative mydriasis-without-cycloplegia strategy (phenylephrine) is also tried for better maintenance of mydriasis but it’s capsule-slackening effect was not thought of. Making best of both, we practice a ‘minimal-cycloplegia mydriasis’ approach (MCM) comprising of 0.25% tropicamide and 5% phenylephrine, instilled in succession. This study was planned to compare our MCM regimen with the conventional fixed-dose-combination regimen of 0.8% tropicamide and 5% phenylephrine (Standard). To compare the ease and smoothness of capsulorrhexis and relative incidence of complications, in hypermature intumescent cataract surgery, between ocular instillation of alternative ‘MCM’ regimen and the traditional ‘Standard’ regimen. The study used a prospective observational 2-arm comparison design. The study commenced with due approval of Institutional Ethics Committee. Sixty-one (61) patients (age range: 42-72yrs, number of Male: Female 19:42) undergoing hypermature intumescent cataract surgery by standard SICS+IOL technique and in whom either of two regimens, MCM or ‘Standard’ were used for papillary dilatation, were observed. Outcome analysis was done by Fisher’s Exact Test. Out of a total of 61 cases, 29 received MCM regime and 32 received ‘Standard’ cycloplegic dilator. Difference in dilatation between two groups was statistically non-significant. Frequency of completed rhexis and attainment of post-operative BCVA of 6/12 were higher with MCM regime: p< 0.001 and p< 0.0005 respectively. Anterior chamber reactions on first post-operative day was more frequent with MCM regime (p<0.01), but was transient and cleared totally in a week. Minimal-cycloplegia dilatation regime comprising of 0.25% tropicamide and 5% phenylephrine, instilled in succession may be preferred for capsulorrhexis in hypermature intumescent cataract.

show abstract

Section: Discussionsupporting

confidence: 93%

Pre-operative minimal-cycloplegia mydriasis for capsulorrhexis in hypermature intumescent cataract

Roy

Ganguli²,

Tripathi³

2023

IJCEO

View full text Add to dashboard Cite

show abstract

“…19 A Cochrane review concluded that cardiovascular-related adverse events were rarely mentioned with IC phenylephrine. 56 Both volume and concentration (= total dose) of IC phenylephrine administered play an important role in the risk of SAEs. Commercially available formulations have the advantage of a precise and accurate concentration.…”

Section: Discussionmentioning

confidence: 99%

“… 19 A Cochrane review concluded that cardiovascular-related adverse events were rarely mentioned with IC phenylephrine. 56 …”

Section: Discussionmentioning

confidence: 99%

Intracameral phenylephrine for surgical mydriasis and intraoperative floppy-iris syndrome: systemic adverse effects and optimal dose

Chua,

Varshney,

Eke

2024

J Cataract Refract Surg

View full text Add to dashboard Cite

Phenylephrine, a potent sympathomimetic, induces mydriasis via iris dilator muscle contraction. Intracameral (IC) phenylephrine has been successfully used in cataract surgery for initial mydriasis, maintaining mydriasis, and management of intraoperative floppy iris syndrome. Serious systemic adverse events (mainly cardiovascular) have been described with topical phenylephrine drops, but we found very little evidence of such adverse events associated with IC phenylephrine use. However, we suspect under-reporting of such adverse events, as they may instead be ascribed to anxiety, positioning, anaesthesia, etc. Optimal dosage/concentrations for IC phenylephrine use in different purposes have not been fully studied. In the absence of robust evidence, we suggest that lower but effective IC phenylephrine concentrations are used: a lower concentration (0.31%), in conjunction with an anticholinergic and lidocaine, may be used for initial mydriasis. For management of intraoperative floppy iris syndrome, 0.31% may be effective, though a higher concentration (1-1.25%) may be required.

show abstract

“…A recent Cochrane review by Iftikhar et al found that topical drops produced larger pupil diameters than intracameral mydriatics in 4 randomized controlled trials (RCTs) at the time of capsulorhexis but rated the certainty of this finding low after downgrading based on risk for bias and imprecision. 1 A comparison of topical and depot delivery mydriatics in the same report found no evidence of a difference in pupil size at the beginning of cataract surgery (size at capsulorhexis was not reported in any of the 7 RCTs), and neither comparison supported a significant effect on operative time. Unsurprisingly, combined preoperative and intraoperative time was significantly reduced by intracameral mydriasis as reported by Labetoulle et al, who also demonstrated a higher number of patients with ocular discomfort at 1 week and 1 month postoperatively in the topical group.…”

mentioning

confidence: 94%

Mydriatic strategies for cataract surgery: optimizing efficacy and cost

Dupps

2021

J Cataract Refract Surg

View full text Add to dashboard Cite

Pharmacologic interventions for mydriasis in cataract surgery

Cited by 6 publications

References 53 publications

Pre-operative minimal-cycloplegia mydriasis for capsulorrhexis in hypermature intumescent cataract

Pre-operative minimal-cycloplegia mydriasis for capsulorrhexis in hypermature intumescent cataract

Intracameral phenylephrine for surgical mydriasis and intraoperative floppy-iris syndrome: systemic adverse effects and optimal dose

Mydriatic strategies for cataract surgery: optimizing efficacy and cost

Contact Info

Product

Resources

About