title: Pupil dilation using a pledget sponge: a randomized controlled trial.
abstract: BACKGROUND
  To show that a pledget soaked in mydriatics and placed in the lower conjunctival fornix is as effective as drops in providing mydriasis for cataract surgery.
  
  
  METHODS
  A randomized, masked, controlled trial of 56 patients assigned to either a pledget group (n=25) or a control eye drops group (n=31) was carried out. Controls had the routine practice of repeated topical mydriatic drops: tropicamide, phenylepherine and atropine. The trial group had a 3-mm pledget trimmed, soaked in mydriatics and placed in the inferior fornix for 20 min. Pupil diameter was measured using a photographic technique with a standard scale shown in each picture. Two masked observers measured the pupils using the scale of the ruler in the developed photograph. All patients completed a 0-10 stinging score prior to surgery.
  
  
  RESULTS
  There were no complications. The mean pupil diameter in the control group was 7.23 (6.91-7.94 95% confidence intervals [CI]) and 7.44 (6.96-7.92 95% CI) in the pledget group. There was no statistically significant difference in pupil diameter between the two groups: difference between means 0.21 (-0.32 to 0.75 95% CI) and Student's t-test of the difference between means (t=0.8 and two-tailed) probability P=0.43. There was no significant difference in the stinging scores: Mann-Whitney test P=0.69.
  
  
  CONCLUSIONS
  The use of a pledget cellulose sponge to deliver mydriatics prior to cataract surgery is as effective as the conventional method of repeated drop administration and was not associated with any adverse effects.
authors.affiliation: Department of Ophthalmology, Arrowe Park Hospital, Wirral, Merseyside, UK. amccormick@slingshot.co.nz
authors.forename: Austin
authors.initials: A
authors.lastname: McCormick
authors.forename: Sathish
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Shabbir
authors.initials: S
authors.lastname: Harun
authors.forename: Mark
authors.initials: M
authors.lastname: Watts
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D002387:Cataract Extraction; D003228:Conjunctiva / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D010656:Phenylephrine / Q000008:administration & dosage; D010781:Photography; D011430:Propoxycaine / Q000008:administration & dosage; D011680:Pupil / Q000502:physiology*; D015503:Surgical Sponges; D014331:Tropicamide / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; D001285:Atropine; C005717:proxymetacaine; D011430:Propoxycaine; D014331:Tropicamide