![]() The study protocol was reviewed and approved by the Institutional Review Board, and a written informed consent was obtained from all participants. Patients with known allergy to tropicamide or phenylephrine were not included. Patients with pseudoexfoliation or anisocoria >0.5 mm at baseline were also excluded. Male patients were also specifically asked about current or previous use of α1-adrenergic receptor antagonists (such as tamsulosin) for prostate problems, and were excluded if their history was positive for their use. Exclusion criteria included any prior ocular trauma or surgery, any ocular condition requiring treatment by intravitreal injections, any ocular condition that affects pupillary function (such as optic neuropathy, Adie’s tonic pupil, oculomotor nerve palsy, and so on), and any use of drops or gels. The purpose of our study was to compare the efficacy in pupil dilation between topical instillation of mydriatic drops and gel, and to compare the degree of patient discomfort during both methods of mydriasis.Īll patients in this study were 18 years or older, and were recruited during their visit at our clinic. It has been suggested that the greater efficacy is owing to the fact that the gel was retained in close proximity to the eye while the drops were cleared by the lacrimal system, and that the gel formulation provided additional permeability through the cornea. 6, 11, 12 One recent study has reported the topical use of a gel containing phenylephrine, tropicamide, diclofenac, and lidocaine for topical anesthesia and mydriasis, which was found to achieve greater and more rapid pupil dilation compared with drops. 9, 10 Use of wicks saturated in mydriatic agents has been shown to be comparable to use of drops, but has been associated with an increased risk of conjunctival and corneal abrasions. ![]() Intracameral injection of mydriatic agents has been shown to be safe and effective, 7, 8 but was reported to be inferior to conventional topical mydriasis in several studies. 6 Therefore, additional methods for pupil dilation have been explored. This process is time consuming, and it has also been shown that repeated instillation of drops may damage the corneal epithelium, which may cause patient discomfort and interfere with the visibility during surgery. Preoperative pupil dilation is commonly achieved by repeated administration of mydriatic drops. 2 An adequately dilated pupil is a prerequisite for safe cataract extraction surgery, and small pupil size has been shown to be associated with increased risk for intraoperative and early postoperative complications. This study is the first report of improved mydriatic efficacy in diabetic patients.Ĭataract is the leading cause of age-related blindness worldwide, 1 and cataract extraction is the most commonly performed ophthalmic surgery. Gel formulation achieved significantly greater pupil dilation than drops, despite a lower concentration of phenylephrine, and was also associated with significantly lower patient discomfort. Use of the gel achieved an even greater degree of pupil dilation in this subset of patients than drops ( P=0.019). In diabetic patients, pupil size was smaller at baseline and following instillation of drops and gel. Use of the gel achieved greater mydriasis than drops ( P=0.01), and was also associated with lower pain scores ( P=0.003). There was no difference in pupil size at baseline. Pain upon instillation was measured by visual analog scale (VAS). Pupil size was measured by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following instillation. One eye was dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other with one drop of gel (tropicamide 0.5%+phenylephrine 5%). ![]() The study included 60 patients with no previous ocular history of trauma and surgery. To compare the efficacy in pupil dilation and degree of discomfort between topical instillation of mydriatic drops and gel.
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