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O. Golan, Y. Hod, O. Geyer; Pupil Dilation With Intracameral Lidocaine During Phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5455.
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Topical mydriatic agents are usually used for pupillary dilation during cataract surgery but they may be associated with untoward side effects. Intracameral lidocaine was reported to be a viable alternative. Pupil dilation by either topical mydriatics or intracameral lidocaine had been compared between patients’ eyes, with one receiving drops and the other receiving lidocaine. We now compared mydriasis by both methods in the same eye.
The pupils of 49 patients scheduled for unilateral phacoemulsification were dilated with topical cyclopentolate 1% and phenylephrine 10% during the preoperative visit and by intracameral preservative-free lidocaine 1% (0.2 mL) injected just before the procedure began. The horizontal pupil diameter was measured before and after pupil dilation using a caliper under operating microscope. Epinephrine (0.5 cc of 1:1000) was added to the irrigation fluid during surgery.
The mean pupil dilation was 5.7 +/- 0.6mm with topical mydriatics and 4.1 +/- 0.8mm with intracameral injection (P < .0001). No statistically significant differences in aobserved in male or female, patients with/without diabetes, eyes with light/darker colored iris, eyes with/without pseudoexfoliation. After intracameral injection adequate mydriasis (mean pupil size 6 +/- 0.8 mm) occurred within 90 seconds and pupil dilation was maintained or increased during the procedure. The overall subjective surgical performance was excellent. No patient required an intracameral mydriatic injection during surgery.
Greater pupillary dilation was achieved with topical mydriatics than with intracameral lidocaine. However, intracameral lidocaine provided adequate intraoperative pupil dilation in routine phacoemulsification surgery.
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