Intracameral Anaesthetic Mydriatic Versus Topical Mydriasis in Pediatric Cataract Surgery: A Randomized Control Study

Area of Science:

• Ophthalmology
• Surgical Innovation
• Pediatric Medicine

Background:

• Pediatric cataract surgery requires adequate pupil dilation for optimal visualization.
• Traditional topical mydriatic drops can be challenging to administer effectively in young children.
• Intracameral formulations offer a potential alternative for achieving consistent mydriasis.

Purpose of the Study:

• To compare pupil dynamics using a premixed intracameral anesthetic mydriatic combination (ICAM) versus traditional topical mydriatic (TM) drops.
• To evaluate the efficacy and stability of mydriasis in pediatric patients undergoing cataract surgery.

Main Methods:

• A randomized, masked, fellow eye-controlled trial was conducted in a tertiary eye care facility.
• Children aged 12 years or younger with bilateral cataracts received ICAM in one eye and TM drops in the fellow eye.
• Pupil dynamics were assessed by a masked observer throughout the surgical procedure.

Main Results:

• Both ICAM and TM drops achieved adequate mydriasis in most patients (93.5% vs. 88.8%).
• Topical mydriatic drops resulted in a larger maximum pupillary diameter (6.75 mm vs. 6.06 mm, P=.004).
• ICAM demonstrated more stable mydriasis throughout surgery, with a positive change in pupillary size, while TM drops showed a trend towards miosis (P=.001).

Conclusions:

• While topical mydriatic drops achieved greater maximum pupil dilation, ICAM provided adequate and stable mydriasis.
• ICAM offers a valuable alternative for achieving consistent pupil dilation in pediatric cataract surgery without the need for augmentation.
• The findings suggest ICAM may improve surgical efficiency and outcomes in pediatric cataract procedures.