Comparison of mydriatic regimens used in screening for retinopathy of prematurity in preterm infants with dark irides.
OBJECTIVE
To determine the mydriatic regimen that provides optimal dilation of the pupil with minimal systemic side effects for screening of retinopathy of prematurity.


METHODS
This cross-sectional, randomized, double-masked clinical trial compared cyclopentolate 1% + phenylephrine 2.5%, tropicamide 1% + phenylephrine 2.5%, and a prepared combination of cyclopentolate 0.2% with phenylephrine 1% for pupillary dilation in preterm infants with dark irides. Thirteen infants were randomized to each regimen. Outcomes measured were pupillary dilation, heart rate, blood pressure, abdominal girth, and intolerance to feeds.


RESULTS
All three mydriatic regimens provided adequate pupillary dilation at 45 minutes, with dilation sustained at 60 minutes. There was a significant increase in mean blood pressure in the cyclopentolate 1% + phenylephrine 2.5% and the tropicamide 1% + phenylephrine 2.5% groups. Although there was no significant change of abdominal girth in any of the three groups, a total of eight patients developed intolerance to feeds; four (50%) of these infants were from the cyclopentolate 1% + phenylephrine 2.5% group.


CONCLUSIONS
The prepared combination of cyclopentolate 0.2% + phenylephrine 1% appears to be the mydriatic of choice for preterm infants with dark irides as it provided adequate pupillary dilation with the least systemic side effects.
Department of Ophthalmology, Faculty of Medicine, University Kebangsaan Malaysia, Malaysia.
Carmen
C
Chew
Ropilah Abdul
RA
Rahman
Suraiya M
SM
Shafie
Zainal
Z
Mohamad
D001794:Blood Pressure / Q000187:drug effects; D003430:Cross-Sectional Studies; D003519:Cyclopentolate / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005127:Eye Color / Q000187:drug effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007498:Iris / Q000187:drug effects*; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D010656:Phenylephrine / Q000008:administration & dosage; D011680:Pupil / Q000187:drug effects*; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D014331:Tropicamide / Q000008:administration & dosage
D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; D003519:Cyclopentolate; D014331:Tropicamide