Same-eye comparison of pupillary dilation with an intraoperative standardized intracameral combination of mydriatics (Mydrane®) versus a preoperative ophthalmic (Mydriasert®) in standard cataract surgery in non-diabetic patients

Summary Introduction Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis. Purpose To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28 mg tropicamide insert and 5.4 mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period. Methods Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45–60 minutes of contact with the insert was manually measured, by two different examiners, through the “iris image” tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2 cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test. Results A hundred and eleven eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21 ± 0.79 mm. The mydriasis obtained with Mydrane® averaged 6.35 ± 0.8 mm. This difference of 0.86 mm was statistically significant (P  Conclusion On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required.