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Surgeon recommends intracameral dilation over eye drop dilation in cataract surgery
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WAIKOLOA, Hawaii — A speaker here encouraged his colleagues to use intracameral dilation over eye drops for pupil dilation prior to cataract surgery.
“We do want our patients’ pupils dilated for surgery,” Ian P. Conner, MD, PhD, said in a presentation here at Hawaiian Eye. “We do want stable, predictable pupillary dilation for anterior segment surgery, but yet our patients often feel overwhelmed by the flurry of activities occurring preoperatively.”
Ian P. Conner
The pros of intracameral dilation are less burden for the post-anesthesia care unit nursing staff, less waste in the post-anesthesia care unit, predictable supply and cost and possible safety gains, Conner said.
The only con for using intracameral dilation is that it must be used with compounded medications, he said.
Researchers conducted a meta-analysis that was published the Journal of Refractive Surgery that compared intracameral mydriasis injections to mydriatic drops. The study found that there was no difference in pupil size, no difference in toxicity, no difference in postoperative vision and sustained dilation throughout the surgery, Conner said.
“My preferred practice now is that none of these preoperative eye drops are in the post-anesthesia care unit. The first eye drop that goes in the eye is the drop of proparacaine or tetracaine just before the betadine prep and 0.1 mL to 0.2 mL of 1% lidocaine, 1.5% phenylephrine immediately before the paracentesis. Put the OVD in to achieve some extra visceral dilation and away you go,” he said. – by Nhu Te
Reference:
Conner I. Eliminating the preoperative post-anesthesia care unit dilating drops. Presented at: Hawaiian Eye 2016 meeting; Jan. 16-22; Waikoloa, Hawaii.
Disclosure: Conner reports no relevant financial interests.