[Clinical use of mydriasis with 10% phenylephrine and its antagonism by 0.5% dapiprazole]

Dapiprazole hydrochloride is an alpha-1-adrenergic inhibitor that anticipates the mydriatic effect of phenylephrine in dilator muscle receptors in a competitive way. The aim of this study was to determine for which indications for mydriasis pupil dilation by phenylephrine alone is sufficient and if the reversal by dapiprazole is convenient and the practical.

In 286 eyes of 147 outpatients, the pupil was dilated for fluorescein angiography-FLA (100 eyes of 50 patients), examination of the fundus-Fd (99 eyes of 52 patients), central argon laser coagulation-cALC) (64 eyes of 32 patients), peripheral argon laser coagulation-pALC (16 eyes of 9 patients) and Nd:YAG capsulotomy (7 eyes of 4 patients) with phenylephrine 10% eyes drops, followed by reversal by dapiprazole 0.5%. The width and mobility of the pupil were tested at intervals of 10 min. When mydriasis by phenylephrine was insufficient, tropicamide was applied additionally.

In 98% of FLA with scanning laser ophthalmoscope, 75% of cALC, 76% of Fd, 62% FLA with fundus camera and 38% of pALC, mydriasis could be reached that was sufficient for the indication. Diabetics showed significantly more sluggish pupil mobility (t1/2: P < 0.05 mydriasis, P < 0.005 reversal). The mean duration after using dapiprazole until reaching the starting value (+/- 1 mm) of the pupil was 44.3 +/- 26.3 min. In 86% of the examined eyes, the pupil reached its starting value within 1 h. The subjective degree of satisfaction with the application of dapiprazole was "satisfied" to "very satisfied" (5.4 +/- 1.4 points on a scale from 1 to 7 points).

In fundus examination, fluorescein angiography by a laser scanner, diagnostic retinal examination and central laser coagulation, the combination phenylephrine/dapiprazole was most suitable. In our opinion, the combination is less suitable for peripheral argon laser coagulation and fluorescein angiography using a fundus camera.