Pupil dilation using a pledget sponge: a randomized controlled trial

Background/Aims: To evaluate and compare cardiovascular effects (blood pressure and heart rate) of phenylephrine 2.5% versus phenylephrine 10%, and compare pupil diameter before and after instillation of eyedrops. Methods: A total of 58 patients scheduled for funduscopy were dilated with either phenylephrine 2.5% and tropicamide 1% (group 0, n = 29 patients, 58 eyes) or phenylephrine 10% and tropicamide 1% (group 1, n = 29 patients, 58 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter, blood pressure and heart rate were measured before and 40 min after eyedrop instillation. Results: We did not observe significant changes in blood pressure or heart rate. Mean pupil diameter in group 0, before the instillation of eyedrops, was 3.51 mm and, in group 1, 2.66 mm. After medication, mean values were 7.38 mm in group 0 and 7.42 mm in group 1. Mean variation was 3.87 mm in group 0 and 4.76 mm in group 1 (p < 0.001). Conclusion: Our results corroborate the finding that one single drop of either 2.5 or 10% phenylephrine is safe and, when 1% tropicamide is combined, satisfactory pupil dilation is achieved.

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“…The time point was chosen based on previous studies [4,5] . A pupillometer was used for measuring the diameter of the pupil.…”

Section: Methodsmentioning

confidence: 99%

Mydriatic and Cardiovascular Effects of Phenylephrine 2.5% versus Phenylephrine 10%, Both Associated with Tropicamide 1%

Motta

Coblentz²,

Fernandes³

et al. 2009

Ophthalmic Res

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“…Due to these problems there has been an attempt to search for alternatives to this repeated eye drop instillation regimen. Various options like single drop instillation,[3] Ocular inserts,[4] depot preparation of mydriatic,[5] and intracameral irrigation of mydriatic-cycloplegic drugs have been used with comparable results. [267] Out of these only intracameral irrigation can obviate the need of pre-operative preparation.…”

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confidence: 99%

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

Gupta¹,

Kumar²,

Agarwal³

et al. 2014

Indian J Ophthalmol

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Context:Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages.Aims:Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure.Settings and Design:The study is a prospective interventional case series, conducted at tertiary care institution.Materials and Methods:Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted.Statistical Analysis Used:Paired samples student–t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis.Results:Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis.Conclusions:Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

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“…Pledgets, such as cellulose sponges, have been soaked in mydriatic agents and placed in the lower conjunctival fornix to successfully replace sequences of mydriatic drops. 2 However, this approach only addresses the issue of nursing time required to instill the drops. Intracameral dilation for cataract surgery avoids issues of epithelial toxicity and the prolonged time required to achieve full dilation.…”

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confidence: 99%

Optimizing the intracameral dilation regimen for cataract surgery: Prospective randomized comparison of 2 solutions

Myers¹,

Shugar²

2009

Journal of Cataract and Refractive Surgery

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Pupil dilation using a pledget sponge: a randomized controlled trial

Abstract: The use of a pledget cellulose sponge to deliver mydriatics prior to cataract surgery is as effective as the conventional method of repeated drop administration and was not associated with any adverse effects.

Cited by 15 publications

References 7 publications

Mydriatic and Cardiovascular Effects of Phenylephrine 2.5% versus Phenylephrine 10%, Both Associated with Tropicamide 1%

Mydriatic and Cardiovascular Effects of Phenylephrine 2.5% versus Phenylephrine 10%, Both Associated with Tropicamide 1%

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

Optimizing the intracameral dilation regimen for cataract surgery: Prospective randomized comparison of 2 solutions

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