The aim of this study is to evaluate the ‘real world’ experience in a UK setting for intracameral Mydrane mydriasis in routine cataract surgery. A prospective consecutive series of 60 patients (group 2) had intraoperative, intracameral Mydrane (tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%) injection, and compared against a ‘control group’- group 1, who received three doses each of topical cyclopentolate 1%, and phenylephrine 2.5%. Topical oxybuprocaine hydrochloride 0.4% was also before surgery. All patients with a history of systemic alpha 1- antagonist use received intracameral phenylephrine 1.25% as standard prior to capsulorhexis in group 1. Preoperative and theatre turnaround time was recorded. Intraoperative pupil size, rate of pupil dilation, intraoperative floppy iris syndrome (IFIS), complications and postoperative visual acuity data were recorded. Postoperative satisfaction survey was collected from patients. Postoperative visual acuity (VA) was comparable between two groups. Comparing group 2 with group 1, preop waiting was less (87 vs. 146 ins; p<0.0001) and satisfaction was higher (76 vs. 66.3; p<0.0001), although the theatre turnaround time was longer (25 mins vs. 22 mins). Pupil size in group 2 was 7mm +/-1mm prior to capsulorhexis and 6.5 +/- 0.29mm after cortical aspiration, with a smaller pupil in patients on alpha-antagonists (4.7+/-1.1mm) at this later time point. The authors concluded that intracameral mydriasis was clinically effective in most patients and a more streamlined flow preop and a positive patient–centered experience. However, based on the extrapolated costs- nursing staff hourly rate in the NHS setting, theatre turnaround time, and Mydrane costs, it was not judged to be cost-effective for the routine use of Mydrane in this particular NHS setting. 

An evaluation of intracameral mydriasis for routine cataract surgery.
Schulz CB, Goverdhan SV, Humphry RC.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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