Intracameral Anaesthetic Mydriatic Versus Topical Mydriasis in Pediatric Cataract Surgery: A Randomized Control Study.

Autor: Sukhija J; From the Advanced Eye Centre (J.S., S.K., K.K., K.G.), Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.. Electronic address: jaspreetsukhija@yahoo.com., Kaur S; From the Advanced Eye Centre (J.S., S.K., K.K., K.G.), Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Kumari K; From the Advanced Eye Centre (J.S., S.K., K.K., K.G.), Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Gupta K; From the Advanced Eye Centre (J.S., S.K., K.K., K.G.), Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Sen I; Department of Anaesthesia (I.S.), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Dec; Vol. 268, pp. 360-367. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1016/j.ajo.2024.08.013
Abstrakt: Purpose: To compare pupil dynamics after using premixed intracameral anesthetic mydriatic combination (ICAM) of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) versus topical mydriatic (TM) drops consisting of tropicamide 0.8%, phenylephrine 5%, and cyclopentolate 0.5% in pediatric cataract surgery.
Design: Randomized, masked, fellow eye-controlled trial.
Setting: Tertiary eye care facility.
Study Population: Children ≤12 years of age with bilateral cataracts planned for surgery. One eye was randomized to receive ICAM and the other eye (control) TM drops.
Intervention: Commercially available ICAM that was injected at the beginning of surgery or TM 3 times at an interval of 30 minutes, 1 hour before the scheduled time of surgery. The other treatment was administered for the second eye cataract surgery.
Main Outcome Measure: Pupil dynamics at various points of surgery were studied by a masked observer.
Results: Sixty-three patients (126 eyes) were randomized to receive ICAM in 1 eye (group 1) or TM drops (group 2). The mean age of the children in the study was 15.7 ± 24.3 months (range 3 months to 5 years). Adequate mydriasis with a single injection was achieved in 93.5% of patients in group 1 and 88.8% of patients in group 2 without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.78 mm to 5.1 mm after injection of 1 unit of ICAM and from 1.75 mm to 6.06 mm with TM drops (P < .0001). The maximum pupillary dilation achieved was 6.06 ± 1.17 mm in group 1 and 6.75 ± 1.07 mm in group 2 (P = .004). The average change in pupillary size from injection of drug until the end of surgery was positive in group 1 (0.75 ± 0.98 mm) and negative in group 2 (-0.3348 ± 2.57 mm), ie, there was a relative miosis in group 2 toward the end of surgery (P = .001).
Conclusions: Topical drugs achieved a larger maximum pupil size compared with ICAM. However, ICAM provided adequate and stable mydriasis without the need for augmentation compared with topical drops in children undergoing cataract surgery.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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