Financial Disclosure

1
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.

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Pupil Dilation During Phacoemulsification
SurgeryComparison 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
3
Purpose

• To evaluate the efficacy of intracameral
  epi-Shugarcaine in the absence of preoperative
  drops on pupil dilation for phacoemulsification
  cataract extraction surgery

4
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.

5
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

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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.

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Results

• The mean age, sex, cataract density, and baseline
  photopic pupil size were comparable between the
  topical and intracameral groups.

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Results
Pupil Dilation (mm) Group A (n9) Group B (n9) P value
Topical gtts 8.0 0.5 -
Epi-Shugarcaine - 5.4 1.3 lt0.0001
Viscoelastic 8.0 0.5 6.1 1.2 lt0.0001
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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

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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.

11
References

• Lundberg B, Behnidig A. Separate and additive
  mydriatic effects of lidocaine hydrochloride,
  phenylephrine, and cyclopentolate after
  intracameral injection. J Cataract Refract Surg.
  2008 Feb34(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-Feb56(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 Jan33(1)101-3.
• Shugar JK. Use of epinephrine for IFIS
  prophylaxis. J Cataract Refract Surg. 2006
  Jul32(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.