Use of a mydriatic cocktail with a wick for preoperative mydriasis in cataract surgery: a prospective randomised controlled trial

Sengupta, Sabyasachi; Subramoney, K; Srinivasan, Renuka; Nongrum, Benjamin; Agarwal, Vikesh; Pandian, D G; Suchismitha, Thotapalli; Kaliaperumal, Subashini

doi:10.1038/eye.2009.23

Cited by 16 publications

(6 citation statements)

References 12 publications

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“…This incidence is lower that in the largest prospective study (n = 167) published to date [10], however α1-ARA medication is only one of the many predisposing factors [29]. Iris billowing – a hallmark of IFIS – was found in similar percentage in the two tamsulosin treated group as in two previous studies [11,24]. …”

Section: Discussionsupporting

confidence: 51%

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Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

et al. 2013

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BackgroundA strong association exists between the use of tamsulosin and the occurance of intraoperative floppy iris syndrome. Several methods were advocated to overcome the progressive intraopertive miosis.Our purpose was to investigate the effect of a mydriatic-cocktail soaked cellulose sponge on perioperative pupil diameter in tamsulosin-treated patients undergoing elective cataract surgery.MethodsPatients using tamsulosin were dilated either with mydriatic-cocktail soaked sponge (group 1) or with conventional eyedrop regimen (group 2). Control patients not taking any α1 adrenergic receptor inhibtors were also dilated with mydriatic sponge (group 3).In all groups oxybuprocain 0.4%, cocain 4%, tropicamide 1%, phenylephrine 10%, diclophenac 0.1% along with chloramphenicol 0.5% were used preoperatively.Pupil diameter (mm) was measured preoperatively, after nucleus delivery, and before IOL implantation. Adverse effects associated with the use of sponge, minor and major intraoperative complications, the use of iris retractors and operation time were recorded.Differences in general between groups were analyzed with a one way analysis of variance (ANOVA); differences between groups in proportions were assessed by Fisher’s exact test.ResultsMean pupil diameter (mm) was preopertively: 7.52 ± 1.21, 7.30 ± 1.55 and 7.99 ± 0.96 (ANOVA: p = 0.079); after nucleus delivery: 6 ± 1.20, 6.29 ± 1.12 and 6.52 ± 0.81 (ANOVA: p = 0.123); before IOL implantation: 5.46 ± 1.06, 5.83 ± 1.09 and 6.17 ± 0.89 (ANOVA: p = 0.0291).No adverse effect related to sponge use was detected. Frequency of minor complications, and iris hook use was similar in the two tamsulosin treated group. Operation time did not differ significantly in the three groups.ConclusionWe have found that using a mydriatic cocktail-soaked wick – an alternative way to achieve intraoperative mydriasis for cataract surgery – was as effective and safe as the conventional repeated eyedrops regiment for tamsulosin treated patients.Trial registrationCurrent Controlled Trials ISRCTN37834752

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Section: Discussionsupporting

confidence: 51%

“…Previous studies indicated that the use of a wick pre-soaked in standard mydriatic and non-steroidal anti-inflammatory drugs was as effective or superior to the conventional repeated instillation of drops before cataract surgery in a mixed cohort [21-24]. …”

Section: Introductionmentioning

confidence: 99%

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

et al. 2013

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“…Sengupta et al . [21] had reported on the use of a mydriatic cocktail with a wick for preoperative mydriasis in cataract surgery. A standard-sized wick soaked for a minute in mydriatic cocktail regimen (equal parts of phenylephrine, cyclopentolate, moxifloxacin, and flurbiprofen) was placed in the inferior fornix for 45 min, and this was found to be superior to topical dilation with regard to size of dilation, cost, patient comfort, and compliance and the main benefit being reduction in nursing time to administer drops.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - A randomized controlled trial

Ajay

Saranya

Sundaresh

et al. 2017

Indian J Ophthalmol

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Purpose:The purpose of this study is to assess the efficacy and safety of intracameral mydriatic solution, as compared to preoperative topical mydriatics, in patients undergoing manual small incision cataract surgery (MSICS) under peribulbar anesthesia. To assess the sustainability of intracameral mydriasis in MSICS by monitoring pupil size at specific junctures during the surgery.Methods:This trial recruited 127 patients, who underwent MSICS under peribulbar block. Mydriasis in topical group was achieved with preoperative topical dilating drops while patients in intracameral group were taken up for surgery without dilation, and mydriasis was achieved intraoperatively with intracameral solution. Pupil sizes were measured serially, at six different junctures during surgery. Time duration of surgery, any intraoperative complications and first postoperative day visual acuity, corneal edema score, and anterior chamber inflammation score were noted in all patients.Results:Mean pupil size just before peribulbar block was 7.3 mm in topical group and 3.3 mm in intracameral group (P < 0.001). Mean pupil size in intracameral group increased to 7.3 mm 30 s after injecting intracameral dilating solution. Mean pupil size in both groups progressively reduced, reaching 5.5 mm (topical group) and 6.2 mm (intracameral group) just before intraocular lens implantation (P = 0.001), and measured 5.1 mm and 5.5 mm, respectively, at the end of surgery (P = 0.048). On first postoperative day, there was no significant difference in distribution of corneal edema scores, AC inflammation scores, and in median logMAR visual acuity between the two groups.Conclusions:MSICS can be performed effectively and safely utilizing intracameral mydriatic solution, without the use of preoperative dilating drops.Trial registration:CTRI/2016/06/007036

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“…This process is time consuming, and it has also been shown that repeated instillation of drops may damage the corneal epithelium, which may cause patient discomfort and interfere with the visibility during surgery. 6 Therefore, additional methods for pupil dilation have been explored. Intracameral injection of mydriatic agents has been shown to be safe and effective, 7, 8 but was reported to be inferior to conventional topical mydriasis in several studies.…”

Section: Introductionmentioning

confidence: 99%

“…9, 10 Use of wicks saturated in mydriatic agents has been shown to be comparable to use of drops, but has been associated with an increased risk of conjunctival and corneal abrasions. 6, 11, 12 One recent study has reported the topical use of a gel containing phenylephrine, tropicamide, diclofenac, and lidocaine for topical anesthesia and mydriasis, which was found to achieve greater and more rapid pupil dilation compared with drops. It has been suggested that the greater efficacy is owing to the fact that the gel was retained in close proximity to the eye while the drops were cleared by the lacrimal system, and that the gel formulation provided additional permeability through the cornea.…”

Section: Introductionmentioning

confidence: 99%

Pupil dilation using drops vs gel: a comparative study

Moisseiev

Loberman

Zunz

et al. 2015

Eye

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PurposeTo compare the efficacy in pupil dilation and degree of discomfort between topical instillation of mydriatic drops and gel.MethodsThe study included 60 patients with no previous ocular history of trauma and surgery. One eye was dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other with one drop of gel (tropicamide 0.5%+phenylephrine 5%). Pupil size was measured by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following instillation. Pain upon instillation was measured by visual analog scale (VAS).ResultsThere was no difference in pupil size at baseline. Use of the gel achieved greater mydriasis than drops (P=0.01), and was also associated with lower pain scores (P=0.003). In diabetic patients, pupil size was smaller at baseline and following instillation of drops and gel. Use of the gel achieved an even greater degree of pupil dilation in this subset of patients than drops (P=0.019).ConclusionsGel formulation achieved significantly greater pupil dilation than drops, despite a lower concentration of phenylephrine, and was also associated with significantly lower patient discomfort. This study is the first report of improved mydriatic efficacy in diabetic patients.

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Use of a mydriatic cocktail with a wick for preoperative mydriasis in cataract surgery: a prospective randomised controlled trial

Cited by 16 publications

References 12 publications

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

Comparing the efficacy of mydriatic cocktail-soaked sponge and conventional pupil dilation in patients using tamsulosin – a randomized controlled trial

Efficacy and safety of intraoperative intracameral mydriasis in manual small incision cataract surgery - A randomized controlled trial

Pupil dilation using drops vs gel: a comparative study

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