Financial Disclosure Drs Nix and Awdeh have no
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Financial Disclosure • Drs. Nix and Awdeh have no financial relationships to disclose. • Dr. Yoo has received consultant, research, and travel reimbursement from Alcon, Carl Zeiss Meditec, and Intra. Lase. • The authors of this poster have no financial interest in the subject matter of this poster.
Pupil Dilation During Phacoemulsification Surgery: Comparison of Topical Anesthetics and Mydriatics Versus Intracameral “Epi-Shugarcaine” Cynthia P. Nix, M. D. Richard M. Awdeh, M. D. Sonio H. Yoo, M. D. Bascom Palmer Eye Institute
Purpose • To evaluate the efficacy of intracameral “epi-Shugarcaine” in the absence of preoperative drops on pupil dilation for phacoemulsification cataract extraction surgery
Methods • A prospective, comparative study of 18 eyes of 18 patients undergoing phacoemulsification cataract extraction surgery by a single surgeon at the Bascom Palmer Eye Institute • Patients on systemic alpha-blockers were excluded.
Methods • Group A (9 eyes): – Pre-operative gtts – 3 cycles q 15 minutes prior to surgery • • phenylephrine 2. 5% cyclopentolate 1% scopoloamine 0. 25% flurbiprofen 0. 03% • Group B (9 eyes): – Intraoperative intracameral injection of “epi. Shugarcaine”
Methods • Vertical Pupil Diameter was measured with surgical calipers – At the start of the case after topical dilating drops (Group A) – Following the injection of “epi-Shugarcaine” (Group B) – And, following the injection of viscoelastic (all eyes) • Time to dilation, iris stability, and surgical complications were recorded.
Results • The mean age, sex, cataract density, and baseline photopic pupil size were comparable between the topical and intracameral groups.
Results Pupil Dilation (mm) Group A Group B P value (n=9) Topical gtts 8. 0 ± 0. 5 - Epi. Shugarcaine - 5. 4 ± 1. 3 <0. 0001 Viscoelastic 8. 0 ± 0. 5 6. 1 ± 1. 2 <0. 0001
Results • Iris stability was comparable between the groups. • Group B had more intraoperative complications (though not statistically significant due to small study size). • There was a subjective difference in surgical performance between the groups – Group B was mildly more difficult due to smaller pupil diameters
Conclusions • “Epi-Shugarcaine” provided rapid and effective mydriasis in eyes that did not receive topical mydriatric drops prior to cataract surgery. • However, pupil dilation was significantly greater in eyes receiving traditional topical mydriatics.
References • Lundberg B, Behnidig A. Separate and additive mydriatic effects of lidocaine hydrochloride, phenylephrine, and cyclopentolate after intracameral injection. J Cataract Refract Surg. 2008 Feb; 34(2): 280 -3. • Nikeghbali A, et al. Pupil dilation with intracameral lidocaine during phacoemulsification: Benefits for the patient and surgeon. Indian J Ophthalmol. 2008 Jan-Feb; 56(1): 63 -4. • Nogoei E. Cataract Surgery: To omit or not to omit? ASCRS Eye. World 2007. • Nikeghbali A, et al. Pupil dilation with intracameral lidocaine during phacoemulsification. J Cataract Refract Surg. 2007 Jan; 33(1): 101 -3. • Shugar JK. Use of epinephrine for IFIS prophylaxis. J Cataract Refract Surg. 2006 Jul; 32(7): 1075 -5. • Myers WG, Shugar JK. Optimizing the intracameral dilation regimen for cataract surgery: Prospective randomized comparison of 2 solutions. J Cataract Refract Surg. 2009 Feb; 35: 273 -6.
