title: Phacoemulsification without preoperative mydriasis in patients with age-related cataract associated with type 2 diabetes.
abstract: OBJECTIVE
  To study the effect of intracameral injection of preservative-free lignocaine to induce pupil dilatation, without using any preoperative dilating eyedrops or intraoperative mydriatics in patients with age-related cataract associated with type 2 diabetes mellitus.
  
  
  METHODS
  This was a prospective, observational, and interventional case series conducted at a tertiary eyecare center in rural India.
  
  
  METHODS
  A total of 32 patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Preoperative pupillary diameter was measured 3 days prior to surgical procedure under mydriatics (tropicamide 0.8%, phenylephrine hydrochloride 5%). Intraoperative pupillary dilatation was achieved by 1% intracameral lignocaine solution alone. Effective phacoemulsification time (EPT), total surgical time, and final pupillary diameter were recorded at the conclusion of surgery.
  
  
  RESULTS
  The average duration of diabetes was 11.2 (range 5-25) years. There was no difference in dilatation by preoperative pupil-dilating drops (5.2±0.5 mm, range 3-8.3 mm) and intracameral 1% lignocaine during the surgical procedure (P=0.63). There was a negative correlation (r=-0.92) between diabetes duration and dilatation of pupils with dilating drops and intracameral lignocaine. The duration of the surgery, EPT, and phacoemulsification chop had statistically insignificant effects on mydriasis, while the grade of the nucleus had a statistically significant effect on mydriasis. Intracameral lignocaine had no significant effect on blood pressure or pulse. There were no surgical complications that could have compromised the visual outcome. None of the patients developed macular edema in a follow-up period of 3 months; 28 patients (87.5%) had best-corrected visual acuity from 20/30 to 20/20.
  
  
  CONCLUSIONS
  Intracameral lignocaine 1% provides sufficient mydriasis for the safe phacoemulsification of cataract in patients with type 2 diabetes of variable duration.
authors.affiliation: Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal, India.
authors.forename: Rajesh Subhash
authors.initials: RS
authors.lastname: Joshi
keywords: intracameral lignocaine; intracameral mydriatic solution; phacoemulsification; topical anesthesia; type 2 diabetes