Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution

Gupta, SK; Kumar, Ajai; Agarwal, Swati; Agarwal, Siddarth

doi:10.4103/0301-4738.109521

Cited by 13 publications

(13 citation statements)

References 34 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average surgical time in our study was 18 minutes, which is more than that of the studies by Nikeghbali et al, Gupta et al, and Joshi et al23,29,33 The average surgical time noted by Joshi et al in age-related cataract was 6.913±4.45 minutes, wherein patients with nondilating pupils and diabetic cataracts were excluded. We could not compare our surgical time, as there is no literature available on the use of only intracameral lignocaine in patients with cataract with type 2 diabetes.…”

Section: Discussioncontrasting

confidence: 47%

“…The pupillary size noted by Nikeghbali et al after intracameral injection of lignocaine was 7.1 mm 23. The pupillary size noted by Gupta et al was 6.9 mm with 0.5% lignocaine and 0.001% epinephrine in routine cataract surgery 33. We did not use epinephrine in irrigating solution.…”

Section: Discussionmentioning

confidence: 60%

“…We could not compare our surgical time, as there is no literature available on the use of only intracameral lignocaine in patients with cataract with type 2 diabetes. The lower surgical times in Nikeghbali et al23 (11.67±3.05 minutes) and Gupta et al33 (13 minutes) could have been due to the inclusion of nondiabetic patients and the use of epinephrine in the irrigation. The extended surgical time in our study could have been related to peculiarities in cataract associated with diabetes of longer duration.…”

Section: Discussionmentioning

confidence: 82%

See 2 more Smart Citations

Phacoemulsification without preoperative mydriasis in patients with age-related cataract associated with type 2 diabetes

Joshi¹

2016

OPTH

View full text Add to dashboard Cite

AimTo study the effect of intracameral injection of preservative-free lignocaine to induce pupil dilatation, without using any preoperative dilating eyedrops or intraoperative mydriatics in patients with age-related cataract associated with type 2 diabetes mellitus.DesignThis was a prospective, observational, and interventional case series conducted at a tertiary eyecare center in rural India.Materials and methodsA total of 32 patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Preoperative pupillary diameter was measured 3 days prior to surgical procedure under mydriatics (tropicamide 0.8%, phenylephrine hydrochloride 5%). Intraoperative pupillary dilatation was achieved by 1% intracameral lignocaine solution alone. Effective phacoemulsification time (EPT), total surgical time, and final pupillary diameter were recorded at the conclusion of surgery.ResultsThe average duration of diabetes was 11.2 (range 5–25) years. There was no difference in dilatation by preoperative pupil-dilating drops (5.2±0.5 mm, range 3–8.3 mm) and intracameral 1% lignocaine during the surgical procedure (P=0.63). There was a negative correlation (r=−0.92) between diabetes duration and dilatation of pupils with dilating drops and intracameral lignocaine. The duration of the surgery, EPT, and phacoemulsification chop had statistically insignificant effects on mydriasis, while the grade of the nucleus had a statistically significant effect on mydriasis. Intracameral lignocaine had no significant effect on blood pressure or pulse. There were no surgical complications that could have compromised the visual outcome. None of the patients developed macular edema in a follow-up period of 3 months; 28 patients (87.5%) had best-corrected visual acuity from 20/30 to 20/20.ConclusionIntracameral lignocaine 1% provides sufficient mydriasis for the safe phacoemulsification of cataract in patients with type 2 diabetes of variable duration.

show abstract

Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 82%

See 1 more Smart Citation

Phacoemulsification without preoperative mydriasis in patients with age-related cataract associated with type 2 diabetes

Joshi¹

2016

OPTH

View full text Add to dashboard Cite

show abstract

“… 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. 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.…”

Section: Introductionmentioning

confidence: 99%

Pupil dilation using drops vs gel: a comparative study

Moisseiev

Loberman

Zunz

et al. 2015

Eye

View full text Add to dashboard Cite

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.

show abstract

“…A study performed by Gupta et al . [ 1 ] reported that intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provided rapid mydriasis which was adequate for safe topical phacoemulsification cataract surgery, and the dilation achieved was unaffected by other parameters. The mydriasis required for phacoemulsification cataract surgery in this study was achieved by the surgeon himself, using intraoperative intracameral solution, without preoperative topical administration of mydriatics.…”

mentioning

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

View full text Add to dashboard Cite

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

show abstract

Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution

Cited by 13 publications

References 34 publications

Phacoemulsification without preoperative mydriasis in patients with age-related cataract associated with type 2 diabetes

Phacoemulsification without preoperative mydriasis in patients with age-related cataract associated with type 2 diabetes

Pupil dilation using drops vs gel: a comparative study

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

Contact Info

Product

Resources

About