[Cycloplegia using a conjunctival insert - comparison to standard procedures]

The widespread combination of tropicamide and phenylephrine eye drops for preoperative mydriasis und cycloplegia is completed by a conjunctival insert called Mydriasert (Théa Pharma GmbH, Berlin) as medicament tracer. This offers potential cycloplegia in a new application form. We tested 10 patients aged 5-41 years (medium 18) with good residual accommodation power. The study design was prospective. We compared the cycloplegic power of either eye drops or conjunctival insert given each at one eye at the same starting point. Then we measured every 15 minutes the pupil width and the accommodation by nearpoint testing. Refraction was measured at the point of smallest accommodation power. As result we found less cycloplegic power of the conjunctival insert (accommodation lag with Mydriasert 3.16 versus tropicamide/phanylephrine eye drops 2.61 D; atropine 1.5 D). The effect of maximal cycloplegia was delayed using the insert (Mydriasert 60 min vs. eye drops 45 min). The subjectively noted comfort for the patients of both application forms is the same using a short interview directly after the testing procedure. In conclusion, the conjuctival medicament insert offers a new application form to induce cycloplegia. The effect is less effective compared to the clinically used standard procedures using eye drops, but should be considered for special patients when eye drop instillation is problematic.