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Intracameral anesthetic mydriatic (ICAM) assisted pediatric cataract surgery
Savleen Kaur1, Shagun Korla1, Jagat Ram1
1Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Intracameral mydriatic-anesthetic combination effectively dilates pupils in pediatric cataract surgery. This safe approach ensures stable mydriasis for successful procedures without additional eye drops.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Pediatric cataract surgery requires adequate pupillary dilation for optimal visualization and surgical outcomes.
- Traditional mydriatic eye drops can be challenging to administer effectively in young children.
Purpose of the Study:
- To evaluate the efficacy and safety of a novel intracameral mydriatic-anesthetic combination for pupillary dilation during pediatric cataract surgery.
Main Methods:
- A prospective study involving 13 children under 12 years undergoing cataract surgery.
- Intracameral injection of phenylephrine hydrochloride (0.31%), tropicamide (0.02%), and lidocaine hydrochloride (1%) was administered at the start of surgery.
- Efficacy was assessed by the ability to perform capsulorhexis and intraocular lens implantation without additional mydriatics.
Main Results:
- Significant pupillary dilation (from 1.92 mm to 5.68 mm) was achieved (p < 0.0001).
- Pupillary dilation showed a strong positive correlation with axial length and horizontal corneal diameter.
- 75% of patients achieved a pupillary diameter greater than 6 mm, enabling successful surgery in all cases without adverse events.
Conclusions:
- Intracameral mydriatic-anesthetic combination provides an effective and safe method for achieving stable mydriasis in pediatric cataract surgery.
- This approach simplifies the surgical process by eliminating the need for repeated topical mydriatic administration.
Purpose:
To assess the efficacy and safety of intracameral mydriatic and anesthetic combination for pupillary dilation in pediatric cataract surgery.
Methods:
This prospective series included children <12 years, with visually significant unilateral or bilateral cataracts planned for cataract surgery with/without intraocular lens implantation. At the beginning of surgery, 0.025 ml of a combination of phenylephrine hydrochloride (0.31%), tropicamide (0.02%), and lidocaine hydrochloride (1%) was injected intracamerally. The efficacy of the combination was tested by achieving capsulorhexis and intraocular lens implantation without additional mydriatics.
Results:
We recruited 13 patients (16 eyes) with a mean age of 4.1 ± 3.9 years. The mean pupillary diameter changed increased from 1.92 to 5.68 mm after injection of one unit (0.025 ml) of drug (p < 0.0001). There was a strong positive correlation of the pupillary dilation with axial length (R = 0.86) and horizontal corneal diameter (R = 0.81). Seventy-five percent patients had a pupillary diameter >6 mm and surgery could be completed successfully in all cases without additional mydriatics. In all cases, pupil dilated as the surgery progressed. No adverse event to the drug was noted.
Conclusions:
Intracameral mydriatic-anesthetic combination is an effective and safe way to obtain stable mydriasis in pediatric cataract surgery.
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