SAFETY OF AN INTRACAMERAL FIXED COMBINATION (MYDORIA) FOR MYDRIASIS AND INTRAOCULAR ANESTHESIA DURING CATARACT SURGERY: A COMPARATIVE STUDY
Main Article Content
Keywords
Safety, Intracameral Fixed Combination (Mydoria), Mydriasis, Intraocular Anesthesia, and Cataract Surgery
Abstract
Background: Effective mydriasis and intraoperative anesthesia are critical for successful phacoemulsification cataract surgery. Traditional topical regimens often require multiple preoperative applications and may cause ocular surface irritation or postoperative complications. Intracameral fixed combinations offer a streamlined alternative that may enhance surgical efficiency and patient comfort. Aim of the study: To compare the safety profile of an intracameral fixed combination of mydriatics and anesthetic (ICMA) with the standard topical mydriatic regimen in patients undergoing phacoemulsification cataract surgery.
Methods: This comparative observational study was conducted in the Department of Ophthalmology at Bangabandhu Sheikh Mujib Medical University (BSMMU) over a 12-month period from August 2016 to July 2017. A total of 150 adult patients diagnosed with age-related cataracts and scheduled for routine phacoemulsification surgery were enrolled following informed written consent. Patients were divided equally into ICMA and Topical mydriatic regimen groups (n=75 each).
Result: There was no statistically significant difference in demographic characteristics between the two groups. Intraoperatively, the ICMA group had a larger pupil (6.8±0.5 mm vs. 6.2±0.6 mm; p<0.01), fewer cases of constriction (6.7% vs. 18.7%; p=0.02), and less need for additional mydriatics (4% vs. 16%; p=0.01). Post-op IOP at 1 hour was lower in ICMA (15.2±2.4 mmHg vs. 16.6±2.8; p=0.01). ICMA showed less pain (1.3% vs. 9.3%; p=0.03) and endothelial cell loss (5.1% vs. 5.7%; p=0.04).
Conclusion: The study concludes that intracameral fixed combinations of mydriatics and anesthetic offer a safer and more effective alternative to traditional topical Mydriatic regimens in cataract surgery.
References
2. Stürmer J. Cataracts—Trend and new developments. Spektrum Augenheilkd. 2009;23(4):171–5.
3. Lamoureux EL, Fenwick E, Pesudovs K, Tan D. The impact of cataract surgery on quality of life. Current opinion in ophthalmology. 2011 Jan 1;22(1):19-27.
4. Lewallen S, Mousa A, Bassett K, Courtright P. Cataract surgical coverage remains lower in women. Br J Ophthalmol. 2008;93(3):295–8.
5. Grob SR, Gonzalez-Gonzalez LA, Daly MK, Yoo SH. Management of mydriasis and pain in cataract and intraocular lens surgery: Survey of ASCRS members and literature review. J Cataract Refract Surg. 2014;40(5):858–65.
6. Westborg I, Mönestam E. Intracameral anesthesia for cataract surgery: A population-based study of safety and patient satisfaction. J Cataract Refract Surg. 2012;38(8):1415–20.
7. Jariyanoravisse B, Sripong P, Panyawatananukul E. The number of mydriatic instillations on pupillary size in cataract patients. Thai J Ophthalmol. 2012;26(2).
8. Morgado AA, Barros JDM, Moraes LV. Comparative study of mydriasis in cataract surgery: Topical versus intracameral. Arq Bras Oftalmol. 2010;73(5):421–5.
9. Greher M, Hartmann B, Pöstinger A. Hypertension and pulmonary edema associated with ophthalmic use of phenylephrine in infants. Anesthesiology. 1998;89(3).
10. Lundberg B, Behndig A. Intracameral mydriatics in phacoemulsification cataract surgery. J Cataract Refract Surg. 2003;29(12):2366–71.
11. Hovanesian JA, Sheppard JD, Trattler WB, Gayton JL, Malhotra RP, Schaaf DT, Ng E, Dunn SH. Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: integrated results from 2 pivotal phase 3 studies. Journal of Cataract & Refractive Surgery. 2015 Oct 1;41(10):2060-8.
12. Westborg I, Mönestam E. Intracameral anesthesia for cataract surgery: a population-based study on patient satisfaction and outcome. Clinical Ophthalmology. 2013 Oct 16:2063-8.
13. Behndig A, Korobelnik JF. Mydriatic insert and intracameral injections compared with mydriatic eyedrops in cataract surgery: Controlled studies. J Cataract Refract Surg. 2015.
14. Shah A, Johal S, Lee N. Mydriasert pupillary dilation for cataract surgery: An economic and clinical study. BMC Ophthalmol. 2015;15:118.
15. Lofoco G, Ciucci F, Bardocci A, Quercioli P. Efficacy of topical plus intracameral anesthesia for cataract surgery in high myopia: Randomized controlled trial. J Cataract Refract Surg. 2008.
16. Ismail R, Sallam A. Complications associated with cataract surgery. Cataract Surgery. 2013 Feb 7.
17. Hovanesian JA, Sheppard JD, Trattler WB. Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: Integrated analysis. J Cataract Refract Surg. 2015.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Md. Sanwar Hossain
Assistant Professor, Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Dr. Md. Arifuzzaman
Vitreo-Retina Consultant, Department of Ophthalmology, Bangladesh Eye Hospital, Dhaka, Bangladesh
Dr. Mohammad Mazaharul Islam
Medical officer, Department of Community Ophthalmology, Bangabandhu Sheikh Mujib
Medical University (BSMMU), Dhaka, Bangladesh
Dr. Md. Golam Faruk Hossain
Assistant Professor, Department of Community Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Dr. Muktar Ali
Senior Consultant, Department of Ophthalmology, Eye Care Hospital, Mali, Maldives
Dr. Tasnim Khanom
Medical officer, Department of Ophthalmology, BIRDEM General Hospital, Dhaka, Bangladesh