Effectiveness of intraoperative, intracameral mydriasis compared to preoperative topical mydriatics, in patients undergoing manual small-incision cataract surgery under peribulbar anesthesia: Randomized single-blind controlled study

Abstract

Abstract Background: Numerous options which include single-drop instillation, ocular inserts, depot preparation of mydriatic, and intracameral irrigation of mydriatic-cycloplegic drugs have also been used which have yielded comparable results. Out of these, only intracameral irrigation with mydriatics can preclude the need for preoperative preparation. Objective: The objective of this study is to assess the effectiveness of intraoperative, intracameral mydriasis as compared to preoperative topical mydriatics, in patients undergoing manual small-incision cataract surgery (MSICS) under peribulbar anesthesia. Methods: This was a randomized single-blind controlled study. One hundred and forty-eight patients who underwent MSICS under peribulbar anesthesia were randomized into two groups. Participants were blinded for the type of treatment. In the topical group (n = 74), we achieved mydriasis by application of topical dilating drops preoperatively, whereas in the intracameral group (n = 74), we achieved mydriasis intraoperatively with an intracameral solution. Pupil sizes were measured, at six different intervals during surgery. Visual acuity was recorded on postoperative day 1 in both groups. Results: Mean pupil diameter just before administration of peribulbar anesthesia was 8.35 mm in the topical group and 2.8 mm in the intracameral group (P < 0.005). Pupil diameter increased to 7.61 mm 30 s after injecting the intracameral mydriatic solution. Mean pupil diameter progressively reduced in further steps of surgery in both groups. Mean pupil diameter measured 7.18 mm (topical group) and 6.84 mm (intracameral group), respectively, just before the removal of the speculum which was statistically significant (P = 0.034). Conclusion: Intraoperative, intracameral mydriatics is an effective method of achieving adequate pupillary dilation during MSICS without the use of preoperative topical mydriatics with satisfactory postoperative visual outcome.