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 IntraLase.

• 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 (n=9) Group B (n=9) P value Topical gtts Epi Shugarcaine 8.0 ± 0.5

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 Feb;34(2):280-3.

A . Separate and additive mydriatic effects of lidocaine hydrochloride, phenylephrine, and cyclopentolate after intracameral injection. J Cataract Refract Surg. 2008 • 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 EyeWorld 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.