Intracameral Versus Topical Mydriasis
Journal of Cataract & Refractive Surgery
Topical mydriatics for cataract surgery require advance preparation, and multiple instillations are needed during the procedure. In a phase 4 trial, Souki et al. compared eyedrops alone to a protocol including a mydriatic-anesthetic solution given intracamerally. They found that intracameral (IC) mydriasis resulted in better ocular surface integrity and higher satisfaction for patients and surgeons.
For this study, researchers enrolled 50 patients between the ages of 40 and 88 years who were slated for bilateral cataract surgery. The patients were assigned randomly to receive either topical drops or an IC mydriatic-anesthetic solution (Mydrane plus Fydrane) plus topical anesthetic drops in one eye for the first surgery. The other treatment was given to the fellow eye for the second surgery. Assessments were performed before surgery, immediately after surgery, at post-op day 1, and at post-op day 7. The primary endpoint was change from baseline in corneal and conjunctival surfaces. Secondary outcomes were epithelial alterations, point-spread function, ocular surface disease index (OSDI), tear film stability assessed by vision breakup time, adverse events (AEs), corrected distance visual acuity (CDVA), intraocular pressure (IOP), patient/investigator satisfaction, and surgery duration.
All eyes received pre-op topical anesthesia (one to two drops of oxybuprocaine chlorhydrate 0.4% + tetracaine chlorhydrate 0.1%). Control eyes also received one drop of tropicamide 1% and phenylephrine 10% at three 10-minute intervals beginning 30 minutes preoperatively, to achieve pupillary dilation. Those randomized to Mydrane/Fydrane received 0.2 mL of the solution, administered slowly into the anterior chamber, just after the first corneal incision.
Changes in corneal and conjunctival surfaces from baseline to day 1 did not differ significantly between treatments, but the Mydrane/Fydrane group had fewer epithelial alterations (p < .005), fewer folliculopapillary reactions (p < .05), shorter procedures (p < .001), less post-op discomfort (p < .05), and greater patient and provider satisfaction (p < .05). AEs were minimal in both groups. Outcomes for point-spread function, CDVA, IOP, and OSDI did not differ significantly but were better with Mydrane/Fydrane.
The original article can be found here.