A Comparison of Mydriatic Eyedrops in Low-Weight Infants

Isenberg, Sherwin J.; Everett, Susan L.; Parelhoff, Edward S.

doi:10.1016/s0161-6420(84)34303-2

Cited by 22 publications

(13 citation statements)

References 8 publications

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“…In our study, there was no statistically significant change in the BP. As in our study, many others [8, 14, 25] did not detect a rise in BP using cyclopentolate 0.5% alone, cyclopentolate 0.5% + tropicamide 0.5%, cyclopentolate 0.5% + phenylephrine 2.5%, Cyclopentolate 0.2% + Phenylephrine 1%, tropicamide 1% + phenylephrine 2.5% eye drops. These differences in studies may be related to the general condition of premature infants in the study groups or the care standards in the neonatal intensive care unit.…”

Section: Discussionsupporting

confidence: 82%

“…Many studies have reported an increase in BP when using phenylephrine 2.5% combined with tropicamide or cyclopentolate 0.5% or 1% [3–5, 7, 8, 24]. On the other hand, Bolt et al [13] did not observe a significant increase in BP after the instillation of the phenylephrine 2.5% plus tropicamide 0.5% combination, and they recommended this combination in order to achieve a sufficient diagnostic mydriasis without any systemic side effects in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of these combinations is to perform ideal dilatation to allow peripheral retinal examination with minimal side effect. Many previous studies have investigated the effects of different combinations of different doses of mydriatics to achieve this goal and did not report exactly identical results of the same mydriatic combinations [3–8]. Nevertheless: a combination of phenylephrine 2.5% plus tropicamide 0.5% ophthalmic drops has generally been reported as safe.…”

Section: Introductionmentioning

confidence: 99%

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Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

2019

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BackgroundTo determine effects and side effects of topical application of phenylephrine 2.5% and tropicamide 0.5% combination in preterm infants.MethodsIn this prospective observational study, 60 infants undergoing retinopathy of prematurity (ROP) screening were prospectively observed. Pupillary diameter, blood pressure, heart rate, and oxygen saturation were monitored before and after up to 24 h during ROP screening examinations.ResultsThe mean pupillary diameter 1 h after the instillation of drops was 5.58 ± 0.75 mm for both eyes. The mean systolic and diastolic pressure and oxygen saturation of infants did not change statistically until the end of the study. The average heart rate decreased by a mean of 4.96 beats/minute from the baseline following eye drops instillation. General condition deterioration, fall in oxygen saturation and bradycardia were observed in 4 infants that already had respiratory distress syndrome.ConclusionThe phenylephrine 2.5% plus tropicamide 0.5% drop is effective and safe as mydriatic combination for retinopathy of prematurity screening. In infants with an additional systemic disease such as respiratory distress syndrome, the side effects of mydriatic drops may be more common. Such babies should be kept under close observation.Trial registrationThe trial was retrospectively registered on 28 February 2018. The ClinicalTrials.gov Identifier is NCT03448640.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

2019

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“…Of all the regimens reviewed for efficacy, phenylephrine 1% and cyclopentolate 0.2% (1–2 d) is the lowest combination dose that provides sufficient pupil dilation 40–42. However, phenylephrine 2.5% and cyclopentolate 0.5% (2–3 d) is the recommended regimen in the UK guideline,3 although there is no known publication evaluating the efficacy of the three-drop regimen.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of mydriatics used for screening of retinopathy in premature infants

Kremer

Reith

Medlicott

et al. 2019

bmjpo

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IntroductionRoutine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines.ObjectiveThis review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination.MethodSystematic literature review.ResultsThere is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports.ConclusionsCurrent international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.

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“…[1][2][3][4] This medication is not without untoward side effects, which may not be evident at the time of the examination 5,6 : feeding intolerance with delayed gastric emptying can occur 24 hours after the drops are instilled.…”

mentioning

confidence: 99%

A randomized controlled trial to determine the lowest effective dose for adequate mydriasis in premature infants

Vicente¹,

Bahri

Palafoutas

et al. 2012

Journal of American Association for Pediatric Ophthalmology and

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A Comparison of Mydriatic Eyedrops in Low-Weight Infants

Cited by 22 publications

References 8 publications

Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

Systematic review of mydriatics used for screening of retinopathy in premature infants

A randomized controlled trial to determine the lowest effective dose for adequate mydriasis in premature infants

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