Optimizing the intracameral dilation regimen for cataract surgery: prospective randomized comparison of 2 solutions

To compare the efficacy of epi-Shugarcaine solution (epinephrine 0.025% and lidocaine 0.75% in fortified balanced salt solution [BSS Plus]) (epi-S) and Lundberg and Behndig's intracameral dilation solution (cyclopentolate 0.1%, phenylephrine 1.5%, and lidocaine 1%) (LB) for intracameral dilation for cataract surgery.

Private clinic, Lincolnwood, Illinois, USA.

In this paired-eye single-masked prospective study, the first eye scheduled for surgery was randomized to receive LB solution or epi-S solution intracamerally at the time of cataract surgery; the second eye to have surgery received the alternative solution. Each eye received 1 drop of tropicamide 1% at least 20 minutes before the start of surgery. Pupil measurements were made before the incision was created, 1 minute after intracameral solution injection, after the anterior chamber was filled with an ophthalmic viscosurgical device, and at the conclusion of the case. Pupil size was objectively graded via software operated by a video technician who was masked to which solution was used.

Eighty-four eyes of 42 patients were enrolled in the study. At each time point after instillation, the pupil was statistically significantly larger with epi-S solution than with LB solution, averaging 0.528 mm larger 1 minute after instillation (mean 7.183 versus 6.665 mm) to 0.34 mm larger (mean 7.381 versus 7.040 mm) by the end of the case.

When combined with 1 drop of tropicamide 1% preoperatively, both formulations provided safe and effective intracameral dilation for cataract surgery; however, the epi-S solution was the more efficacious at each step of the procedure.