Pupil dilation using a pledget sponge: a randomized controlled trial.
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.
McCormick
Austin
A
Department of Ophthalmology, Arrowe Park Hospital, Wirral, Merseyside, UK. amccormick@slingshot.co.nz
Srinivasan
Sathish
S
Harun
Shabbir
S
Watts
Mark
M
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
D000779:Anesthetics, Local; D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; D001285:Atropine; C005717:proxymetacaine; D011430:Propoxycaine; D014331:Tropicamide