Research Article - Journal of Clinical Ophthalmology (2019) Volume 3, Issue 2
Comparative evaluation of pupillary dilatation with intracameral injection of preservative-free 1% lidocaine and topical mydriatic in phacoemulsification surgery
Purpose: To compare the efficacy of pupillary dilation by intraoperative intracameral injection of preservative-free lidocaine 1% and conventional topical mydriatics during phacoemulsification cataract surgery.
Methods: A randomized comparative interventional study was conducted which included 50 patients. Group 1 and group 2 included 25 patients each who were given topical mydriatics and intracameral lidocaine respectively to dilate the pupil for phacoemulsification and intraocular lens implantation. The topical group received 3 drops of tropicamide 0.8% and phenylephrine 5% eye drops given 15 minutes apart starting 45 minutes before surgery. The intracameral group received preservative-free lidocaine 1% (0.2 to 0.3 mL) injected intraoperatively. In both groups, horizontal pupil diameter before and after pupil dilation and total surgical time were recorded. The need for a mydriatic agent during the procedure, subjective surgical performance, ocular and systemic side effects between the two groups was also assessed.
Results: The mean age, sex, cataract density, baseline horizontal pupil diameter, and the mean duration of the surgery were statically insignificant between the topical group and intracameral group. The mean pupil dilation was 4.62 ± 0.96mm in the intracameral group and 4.76 ± 0.75 mm in the topical group (p=0.57). There was no significant difference between groups in the overall subjective surgical performance (p=0.72).
Conclusion: Intracameral lidocaine (ICL) is a safe, effective and reliable alternative against topical mydriatic for pupil dilatation with added advantages of fast recovery postoperatively and avoiding the side effects by systemic absorption of topical mydriatics. Nonetheless, intracameral lidocaine has good patient compliance with additive anesthetic effect.Author(s): Nikhil Agrawal