Intracameral mydriatics in phacoemulsification surgery obviate the need for epinephrine irrigation.
OBJECTIVE
To evaluate the possibility of removing epinephrine from the irrigating solution in phacoemulsification surgery when using intracameral mydriatics (ICMs).


METHODS
We carried out a prospective, randomized, double-blinded study of 140 patients with age-related cataracts, scheduled for unilateral phacoemulsification. The first part of the study involved 90 patients divided into two groups. Patients in both groups were given 150 microl ICMs at the beginning of the procedure. In group 1, 0.6 microg/ml epinephrine was added to the irrigating balanced salt solution. No epinephrine was added to the irrigation solution used in group 2. The second part of the study involved 50 patients, all of whom were given topical mydriatics (TMs) and then similarly divided into two groups and treated as in the first study setting.


RESULTS
With ICMs, pupil sizes generally increased during the procedures. Remarkably, this increase was significantly greater without epinephrine (13 +/- 19% versus 4 +/- 14%; p = 0.02). In the TMs setting, pupil sizes decreased intraoperatively in both groups; significantly more without epinephrine (- 5 +/- 4% versus - 12 +/- 7%; p < 0.001).


CONCLUSIONS
An irrigating solution without epinephrine can safely be used with ICMs. The increase in pupil size during the procedure is greater without epinephrine. This study also confirms earlier findings that epinephrine is beneficial when using TMs.
Lundberg
Björn
B
Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden. bjorn.lundberg@ophthal.umu.se
Behndig
Anders
A
D000368:Aged; D003519:Cyclopentolate / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D009184:Mydriatics / Q000008:administration & dosage*; D018918:Phacoemulsification; D010656:Phenylephrine / Q000008:administration & dosage; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D007507:Therapeutic Irrigation
D009184:Mydriatics; D010656:Phenylephrine; D008012:Lidocaine; D003519:Cyclopentolate; D004837:Epinephrine