Is routine pupil dilation safe among asian patients with diabetes?
OBJECTIVE
To investigate the risk of acute angle closure (AAC), changes in intraocular pressure (IOP), and factors associated with these outcomes after routine pupil dilation in a cohort of Asian subjects with diabetes mellitus.


METHODS
The study was a prospective observational case series of 1910 consecutive Asian subjects newly referred for assessment of diabetic retinopathy at a tertiary clinic. All subjects underwent routine pupil dilation unless there was a prior history of angle-closure glaucoma. Noncontact air-puff tonometry was used to assess IOP, which was measured by the same observer before and 1 hour after pupil dilation. Subjects were assessed for signs and symptoms of AAC before leaving the clinic, and their charts were also subsequently reviewed for revisits with AAC.


RESULTS
Of the 1910 subjects who participated, none developed AAC. Sixty-nine subjects (3.6%, 95% CI: 2.8%-4.5%) showed an increase in IOP of >or=5 mm Hg in the either eye, 37 subjects (1.9%, 95% CI: 1.4%-2.6%) had a postdilation IOP >25 mm Hg in either eye, and only 10 subjects (0.52%, 95% CI: 0.25%-0.96%) had an increase in IOP >or=5 mm Hg and had a postdilation IOP >25 mm Hg in either eye. The level of predilation IOP and a known history of glaucoma were significant risk factors for a postdilation IOP >or=25 mm Hg.


CONCLUSIONS
In this cohort of Asian persons with diabetes, the risk of AAC was insignificant after routine dilation of pupils for fundus examination. These data substantiate the safety of routine dilation of pupils in Asian patients with diabetes.
Tan
Gavin S
GS
Singapore National Eye Centre, Singapore.
Wong
Ching-Yee
CY
Wong
Tien Yin
TY
Govindasamy
Chitra V
CV
Wong
Edmund Y
EY
Yeo
Ian Y
IY
Aung
Tin
T
D044466:Asian People; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D004338:Drug Combinations; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage* / Q000009:adverse effects; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects*; D012307:Risk Factors; D012846:Singapore / Q000208:ethnology; D014065:Tonometry, Ocular; D014331:Tropicamide / Q000008:administration & dosage / Q000009:adverse effects
D004338:Drug Combinations; D009184:Mydriatics; D010656:Phenylephrine; D014331:Tropicamide