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A.A. Obi, A. Penwarden, M. Niskopolou, T. Poole; Minimum Eyedrop and Intracameral Pupil Dilation for Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):749.
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Purpose: To assess the efficacy of a minimal eyedrop regimen combined with intracameral lignocaine hydrochloride 1% on pupil dilation in cataract surgery Methods: 32 consecutive eyes undergoing phacoemulsification cataract surgery had 1 drop of phenylephrine 2.5% instilled twice in the 30 minutes prior to surgery. Dilatation was completed with 0.3ml lignocaine hydrochloride 1% injected intracamerally. Pupil size was measured immediately prior to surgery, at maximal dilatation and at the end of the operation. The surgeon scored the adequacy of pupil dilatation for surgery. To aid comparison with accepted methods, 10 patients’ pupils were dilated at preoperative assessment with the standard dilatation regimen of 4 drops each of 1% cyclopentolate and 2.5% phenylephrine. Results: The mean maximal dilation was 7.60mm and the mean surgical satisfaction score was 7/10. Maximal pupil dilatation was maintained till the end of surgery in 91% of eyes. Pupil constriction of 2mm or more was seen in 9% of eyes. Poor pupil tone was noted in 10% of eyes. The mean pupil dilation of the 10 pupils dilated at preoperative assessment with the standard regimen was 8mm. Conclusions: This technique has implications for reduction in corneal epithelial drop toxicity and improved day unit and patient convenience and was found to be largely acceptable, with a caveat that maximal pupil diameter tended to be 0.5mm smaller than with standard dilatation. There were reservations however about implementing its general use as pupil size appeared to be less stable with intracameral dilation, with a tendency for the pupil to constrict during the procedure in some cases, particularly brown eyes. In two eyes this required the use of a pupil dilatation device. We have therefore reverted to standard drop dilatation for routine use and particularly for trainee surgeons, .
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