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Ivan Sychev, Matthew Fenech, Raly Job Vellaniparambil, Dan Nguyen, Pedro Muel-Gonzalez; Is preoperative tropicamide required when using Mydrane?. Invest. Ophthalmol. Vis. Sci. 2019;60(9):488. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Mydrane, the first commercially-available intracameral combined mydriatic and anaesthetic preparation, does not require preoperative eye drop application, reducing nursing time and minimising systemic uptake. Anecdotal evidence reports that pupil stability may be improved by additional topical tropicamide preoperatively. Our study aims to document if preoperative tropicamide in combination with Mydrane influences pupil stability and intraoperative mydriasis in a real-world setting.
In a local evaluation of cataract surgery 69 eyes of 69 patients received Mydrane, with 38 also having one drop of preoperative tropicamide 1%.Maximum pupil diameter following Mydrane injection, after introduction of Ophthalmic Viscosurgical Device (OVD) and after OVD removal was noted. Total surgical time, extra measures to maintain mydriasis and intraoperative complications were also recorded. Patients identified at listing as likely to require dilating adjuncts were excluded. Two-tailed t-test was used for statistical analysis.
Our results show superior stability in the Mydrane alone (Group 1) vs tropicamide plus Mydrane (Group 2) in the maintenance of mydriasis. The stability of mydriasis (mean change of pupil diameter after OVD injection until just before intracameral cefuroxime) was superior (p=0.02) in Group 1 (-0.46±0.54mm) vs Group 2 (-0.82±0.64mm). However, the mean pupil size prior to and after OVD injection favoured pre-op tropicamide (p=0.0003 and p=0.0230, respectively). Mean pupil size of 6.21mm (range 4-8) was achieved following Mydrane administration in Group 1 vs 7.21mm (range 5-9.5) in Group 2. Injection of OVD reached a mean pupil size of 7.02mm (range 4-9) in Group 1 vs 7.68mm (range 5.5-10) in Group 2. At the end of surgery the mean pupil size was 6.68mm (range 4-9) in Group 1 vs 6.85mm (range 3.5-9) in Group 2 (p=0.6153). Three patients in the Mydrane alone group required adjuncts for maintenance of mydriasis compared to one patient in the combined group. There was no significant difference in mean surgical time between groups (mean 12.59 ± 4.79 minutes in Group 1 vs 12.32 ± 5.4 minutes in Group 2, p=0.83) after exclusion of two cases of posterior capsule rupture.
Additional preoperative tropicamide eyedrop does not appear to improve the maintenance of mydriasis achieved with Mydrane during cataract surgery. However, it does appear to increase overall intraoperative mydriasis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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