Use of a mydriatic cocktail with a wick for preoperative mydriasis in cataract surgery: a prospective randomised...

To investigate the efficacy of a standardised wick soaked in a mydriatic cocktail regimen and compare it with the pre-existing regimen of topical dilating drops.

Prospective, two armed, randomised, double blind, parallel assignment efficacy study.

In all, 150 eyes of 150 patients were dilated using the dilating cocktail regimen by using a Weck cell sponge. The control group comprised of 75 eyes of 75 patients dilated using the conventional mydriatic regimen.

A specially prepared mydriatic cocktail regimen consisting of 1 : 1 : 1 : 1 ratio of 2.5% phenylephrine, 0.5% moxifloxacin, 1% cyclopentolate, and 0.03% flurbiprofen eye drops was prepared. A standard sized wick (1 cm x 2 mm) made of Weck cell sponge was soaked in the cocktail for a minute and placed in the lower fornix with sterile forceps. In the control group, eyes were dilated with the above drops using topical instillation in every 15 min. The mydriasis was measured at 15, 30, and 45 min after instillation using the Procyon pupillometer under scotopic conditions (0.04 lux). The intraoperative maintenance of mydriasis was measured with calipers after nucleus delivery and after intraocular lens implantation.

Pupillary diameters at the end of 15, 30, and 45 min, and intraoperative maintenance of mydriasis in the two groups were compared using unpaired t-test.

There was a statistically significant difference (P<0.001) in dilation achieved at the end of 45 min in both groups. There was also a significant difference of 1-mm dilation between the two groups after nucleus delivery (P< 0.001), and a difference of 1.41 mm after intraocular lens implantation, which was statistically significant (P<0.001).

These results show that the mydriatic cocktail regimen delivered with a wick is a useful, economical, and timesaving regimen compared with the conventional method of preoperative mydriasis using topical drops.