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Efficacy of Intracameral Mydriatics in Pediatric Lens Surgery
Luc Van Os1,2, Kristien Wouters3, Hanne Herbots4
1Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.
Insights
Intracameral Mydrane effectively dilated pupils in 75% of pediatric lens surgery patients, eliminating the need for additional pupil expansion techniques. This safe and effective method is suitable for pediatric lens surgery.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Pharmacology
Background:
- Pupillary dilation is crucial for pediatric lens surgery.
- Traditional mydriatic eye drops may be insufficient or difficult to administer in children.
- Intracameral Mydrane offers a potential alternative for achieving adequate pupil dilation.
Purpose of the Study:
- To evaluate the efficacy and safety of intracameral Mydrane for pupil dilation in children undergoing lens surgery.
- To assess the rate of sufficient pupillary dilation without additional maneuvers.
- To identify factors influencing Mydrane's response in pediatric patients.
Main Methods:
- Prospective cohort study of 40 pediatric patients (8 weeks to 17 years) undergoing lens surgery.
- Single intracameral injection of 0.1 mL Mydrane without preoperative eye drops.
- Measurement of pupil size and monitoring during surgery.
Main Results:
- Sufficient pupillary dilation was achieved in 75% of patients without additional interventions.
- Poorer response was associated with younger age, male sex, and smaller horizontal corneal diameter.
- No adverse events were observed, and mydriasis persisted throughout surgery.
Conclusions:
- Intracameral Mydrane is an effective and safe option for pupil dilation in pediatric lens surgery.
- The drug provided adequate dilation in the majority of cases, simplifying surgical procedures.
- Patient factors like age and corneal diameter influence the degree of mydriasis achieved.
Introduction:
The aim of this study was to evaluate the efficacy of intracameral administration of Mydrane® in children undergoing lens surgery.
Methods:
We set up a single center prospective cohort trial including 40 consecutive patients between 8 weeks and 17 years old who were planned for lens surgery, including cataract, persistent fetal vasculature or lens subluxation. We injected 0.1 mL of intracameral Mydrane at the beginning of surgery, no preoperative mydriatic eye drops were used. The aim of the study was to measure pupil size and to monitor the evolution of the pupil size during surgery and the need for additional pupil expanding techniques.
Results:
In 30 patients (75% [95% CI: 59-87%]), we did not need additional manipulations to obtain sufficient pupillary dilatation to perform the surgery and to implant an intraocular lens following the bag-in-the-lens (BIL) technique. In the remaining 10 patients (25%), we saw an initiation of dilatation but not to the required pupil diameter to continue the surgery without additional surgical maneuvers. The duration of surgery was significantly longer in the partial response group, reflecting the need for additional surgical steps. A significant relation between increase of pupillary diameter and age (p = 0.003), gender (p = 0.032), and horizontal corneal diameter (p < 0.001) could be shown. Even at baseline, there is a larger pupil diameter in eyes with larger horizontal corneal diameters (p = 0.039). No adverse events were observed during this study.
Conclusion:
Intracameral administration of Mydrane resulted in some degree of dilatation in all eyes in this series, 75% of eyes did not need additional techniques to proceed with the surgery. Smaller pupils at baseline, younger age, male sex and small horizontal corneal diameter were related to a poorer response to Mydrane. The mydriasis persisted for the entire duration of the surgery, no ocular adverse events were observed during this study. This leads us to conclude that intracameral Mydrane is an effective and safe way to dilate the pupil in pediatric lens surgery.
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