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Pharmacologic interventions for mydriasis in cataract surgery.

Mustafa Iftikhar1, Samuel A Abariga2, Barbara S Hawkins1

  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

The Cochrane Database of Systematic Reviews
|May 27, 2021
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Summary

This review found insufficient evidence to determine the best method for pupil dilation during cataract surgery. More high-quality research is needed to compare topical, intracameral, and depot mydriatics for safety and effectiveness.

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Area of Science:

  • Ophthalmology
  • Surgical Procedures
  • Pharmacology

Background:

  • Cataract surgery is a common procedure worldwide.
  • Adequate pupillary dilation (mydriasis) is crucial for surgical safety and efficacy.
  • Poor dilation can impede the surgeon's view and instrument manipulation.

Purpose of the Study:

  • To compare the effectiveness of topical, intracameral, and depot mydriatics for pupillary dilation during phacoemulsification (cataract extraction).
  • To assess and compare intraoperative and postoperative complications associated with each dilation method.
  • To evaluate the cost-effectiveness of the different pupillary dilation approaches.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases (CENTRAL, MEDLINE, Embase, PubMed, LILACS, ClinicalTrials.gov, ICTRP) without date or language restrictions.
  • Included 14 RCTs involving 1670 eyes of 1652 participants comparing topical, intracameral, or depot mydriatics.

Main Results:

  • Evidence was insufficient to determine superiority of any method due to heterogeneity and low certainty.
  • Topical mydriatics showed a potential for greater pupillary diameter at capsulorhexis compared to intracameral, but with low certainty.
  • Ocular discomfort may be higher with topical mydriatics post-surgery (moderate certainty); iris complications were noted with intracameral mydriatics (very low certainty).

Conclusions:

  • Current data from 14 RCTs are inadequate to establish the superiority of any mydriasis method for cataract surgery.
  • Only one trial had sufficient sample size for robust effect estimation.
  • Larger, well-designed trials are necessary to provide reliable comparisons of mydriasis approaches and their effects.