title: Anaesthetic plus dilating gel improves pupil dilation for cataract surgery.
abstract: OBJECTIVE
  To evaluate the efficacy of a combination anaesthetic plus dilating gel (ADG) on pupil dilation (PD) and corneal anaesthesia (KA) compared to traditional preoperative pharmacotherapy for cataract surgery.
  
  
  METHODS
  Prospective, noninferiority study.
  
  
  METHODS
  We studied 20 consenting adults who experienced unilateral cataracts and underwent routine cataract surgery, receiving the traditional preoperative pharmacologic regimen in the operated eye (control eye): diclofenac 0.1%, gentamicin 0.3%, cyclopentolate 1%, phenylephrine 2.5%, and tropicamide 1% 60 and 20 minutes prior to surgery. They then received tetracaine 0.5% and povidone-iodine 5% 10 minutes prior to surgery; and were given tetracaine 0.5%, povidone-iodine 5%, and lidocaine 2% gel 1 minute prior to surgery. Epinephrine 0.1%, 1 cc per 500 mL bag of balanced saline salt solution was administered during surgery. The nonoperated eye (study eye) received tetracaine 0.5%, povidone-iodine 5%, and 0.35 cc ADG gel (phenylephrine 10%, tropicamide 1%, diclofenac 0.1%, and lidocaine 2%) 60 and 10 minutes prior to surgery. PD and KA were measured at baseline, at 30 minutes, and at 5 minutes prior to surgery, and at 5 minutes after surgery.
  
  
  RESULTS
  There was no difference in PD (p = 0.2634) or KA (p = 0.6058) between the study eyes and the control eyes at baseline. Preoperatively, greater mydriasis was achieved in the study eye (7.95 ± 0.91 mm vs 7.17 ± 1.25 mm; p < 0.0001). There was no significant difference in preoperative KA between the study and control eyes (1.5 ± 2.2 mm vs 1.4 ± 2.1 mm; p = 0.77).
  
  
  CONCLUSIONS
  The combination ADG for preoperative preparation of cataract patients achieves at least equivalent dilation and corneal anaesthesia as the current preoperative pharmacologic regimen.
authors.affiliation: Department of Ophthalmology, Queen's University. Kingston, Ontario, Canada. delan.jinapriya@queensu.ca
authors.forename: Delan
authors.initials: D
authors.lastname: Jinapriya
authors.forename: David R P
authors.initials: DR
authors.lastname: Almeida
authors.forename: Davin
authors.initials: D
authors.lastname: Johnson
authors.forename: Isabella
authors.initials: I
authors.lastname: Irrcher
authors.forename: Sherif R
authors.initials: SR
authors.lastname: El-Defrawy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002387:Cataract Extraction; D003315:Cornea / Q000502:physiology; D004008:Diclofenac / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage*; D010656:Phenylephrine / Q000008:administration & dosage; D011206:Povidone-Iodine / Q000008:administration & dosage; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects*; D013748:Tetracaine / Q000008:administration & dosage; D016896:Treatment Outcome; D014331:Tropicamide / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D005782:Gels; D009184:Mydriatics; D013748:Tetracaine; D004008:Diclofenac; D010656:Phenylephrine; D011206:Povidone-Iodine; D008012:Lidocaine; D014331:Tropicamide