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Gurpreet Kaur Bhogal-Bhamra, James Wolffsohn, Paramdeep Bilkhu, Maria Vidal-Rohr, Janis B. Orr; Pupil Dilation and Ocular Surface Effects with an Ocular Insert compared to Repeated Topical Drops. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4336.
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© ARVO (1962-2015); The Authors (2016-present)
Standard practice within Ophthalmology and ocular surgery requires maximal pupil dilation through topical instillation of tropicamide and phenylephrine. Ensuring adequate dilation prior to ocular examination or surgery commonly requires multiple drop instillations. It has been established that the cornea undergoes various shape changes during dilation and is thus reasonable to assume the ocular surface may be compromised with repeated drug instillation. There is, however, little evidence within literature investigating ocular surface changes with sequential instillation of topical drops. Mydriasert® (Laboratoirs Thea, France), an ophthalmic insert which releases tropicamide and phenylephrine, offers as an alternative to multiple topical mydriatics for pupil dilation. The purpose of this study was thus to investigate the effects of sequential instillation of dilating drops on the ocular surface in comparison to Mydriasert.
Thirteen healthy subjects (6 females and 7 males, mean age 21±3.6 years) with no ocular pathology underwent sequential dilation in one eye randomly selected using Tropicamide 1% and Phenylephrine 2.5%; the contralateral eye was dilated using Mydriasert. Drops were instilled every 20minutes for a total duration of 80 minutes. Ocular comfort, redness, pupil size, central corneal thickness (CCT - Vistante OCT), corneal biomechanics (Ocular Response Analyzer) and corneal and conjunctival staining were assessed at 20 minute intervals by masked observers over 80 minutes.
Mydriasert and drop eyes were similar at baseline (p>0.05). Both methods gave similar average dilation (F=0.263, p=0.617), with the Mydriasert eyes showing less dilation 20mins after instillation (p<0.01), but achieving a wider dilation by 60mins (by 0.52±0.58mm; p<0.01). Mydriasert eyes also showed less ocular redness over time (F=6.619, p=0.024). Both methods of dilation increased CCT (F=5.552, p<0.001) but had no significant impact on corneal biomechanics (p>0.05) or ocular surface staining (F=0.050, p=0.826).
A dilation insert was equally effective as multiple dosing of topical drops, achieving a higher level of dilation with less ocular redness and involving less staff time.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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