title: Comparison of Preoperative Topical Dexamethasone Phosphate Versus Ketorolac Tromethamine in Maintaining Intraoperative Mydriasis During Small Incision Cataract Surgery.
abstract: BACKGROUND
  Intraoperative miosis is one of the many challenges which a surgeon can face during cataract surgery. It may lead to impaired view and difficulty in delivering the nucleus. Also, it increases the chances of more serious intraoperative and postoperative complications. Therefore, maintaining adequate pupillary dilatation is of utmost importance during cataract surgery.
  
  
  OBJECTIVE
  To study the efficacy of topical dexamethasone phosphate (0.1%) and topical ketorolac tromethamine (0.4%) in maintaining pupillary dilatation during cataract surgery.
  
  
  METHODS
  A total of 200 patients were studied. These were randomly divided into two groups of 100 each. Group1 was given topical dexamethasone phosphate (0.1%) and Group 2, topical ketorolac tromethamine (0.4%). Medications were started 1-day before surgery in the form of one drop to be instilled every 6 hours. Pupillary diameter was measured in the horizontal meridian; 4 readings were taken - before making the incision, after nucleus delivery, following cortical clean-up and after Intraocular Lens (IOL) implantation.
  
  
  RESULTS
  The two drugs showed no statistically significant difference in pupillary diameter at the commencement of surgery (p=0.435). The difference between the two drugs was statistically significant, for the mean pupillary diameter which changed from the start of surgery to after cortical clean-up. At this stage, ketorolac group showed a tendency towards larger mean pupillary diameter than dexamethasone group (6.70 ± 0.85mm and 6.32 ± 0.84mm, respectively, p=0.002). Again, ketorolac group patients had larger pupillary diameter after IOL implantation than dexamethasone group patients (the mean was 6.16± 0.97mm and 5.75 ± 0.73mm, respectively, p=0.001).
  
  
  CONCLUSIONS
  Both ketorolac tromethamine (0.4%) and dexamethasone phosphate (0.1%) are effective in maintaining adequate mydriasis during cataract surgery, but the comparative analysis of the two drugs concludes that, ketorolac is definitely a better option in preventing surgically induced miosis.
authors.affiliation: Professor, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India .
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Sharma
authors.affiliation: Associate Professor, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India .
authors.forename: Hans Raj
authors.initials: HR
authors.lastname: Sharma
authors.affiliation: Senior Resident, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India .
authors.forename: Rajni
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Resident, Department of Ophthalmology, Government Medical College , Jammu, Jammu and Kashmir, India .
authors.forename: Amrita
authors.initials: A
authors.lastname: Singh
keywords: Corticosteroids; Miosis; Non-steroidal anti-inflammatory drugs