Pupil size with and without adrenaline with diclofenac use before cataract surgery
Received 1 February 2009; received in revised form 17 March 2009; accepted 18 March 2009.
Purpose
To determine whether adrenaline in the irrigating solution is necessary when diclofenac eyedrops are used before cataract surgery.
Setting
Pasqua Hospital, Regina, Saskatchewan, Canada.
Methods
In this prospective randomized masked study, all patients used diclofenac eyedrops 2 days preoperatively. The pupils were dilated with a wick soaked in a dilating solution containing diclofenac. Patients were divided into 2 groups. One group had 0.5 mL of 1:1000 adrenaline in 500.0 mL of fortified balanced salt solution (BSS Plus) (adrenaline group). The other group did not (no-adrenaline group). The horizontal diameter of the pupils was measured with calipers.
Results
The study included 207 patients. There were no surgical complications. In the adrenaline group, the mean pupil size was 8.19 mm ± 0.86 (SD) before the first incision, 8.14 ± 0.87 mm after phacoemulsification, and 8.14 ± 0.85 mm after cortical removal. In the no-adrenaline group, the means were 8.19 ± 0.87 mm, 7.94 ± 0.99 mm, and 7.87 ±1.03 mm, respectively. The mean pupil constriction was 0.05 ± 0.21 mm in the adrenaline group and 0.33 ± 0.43 mm in the no-adrenaline group. The difference was statistically significant (Mann-Whitney test). Further analysis of preoperative pupil size showed a significant difference for smaller pupils only.
Conclusions
When diclofenac eyedrops were used before cataract surgery, the smaller preoperative pupils constricted significantly less when adrenaline was added to the irrigating solution. This was not true for larger pupils. Thus, adrenaline in the irrigating solution does not appear necessary in eyes with large preoperative pupils.
From the University of Saskatchewan and Pasqua Hospital (Ong-Tone) and Research Performance and Support (Bell), Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
Neither author has a financial or proprietary interest in any material or method mentioned.
Presented in parts at the XXVI Congress of the European Society of Cataract & Refractive Surgeons, Berlin, Germany, September 2008 and at the ASCRS Symposium on Cataract, IOL and Refractive Surgery, San Francisco, CA, USA, April 2009.
The operating room nursing staff contributed to the study.
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