Effect of topical nonsteroidal anti-inflammatory drugs and nuclear hardness on
maintenance of mydriasis during phacoemulsification surgery.
Author(s): Liu C(1), Liu Y, Ye S, Liu L, Zhang W, Wu M.
Affiliation(s): Author information:
(1)1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun
Yat-Sen University , Guangzhou, China .
Publication date & source: 2014, J Ocul Pharmacol Ther. , 30(10):831-6
PURPOSE: To compare the effects of topical nonsteroidal anti-inflammatory drugs
on pupil dilation maintenance during phacoemulsification cataract surgery and
quantify the relationships between pupil size change and nuclear hardness.
METHODS: This prospective randomized clinical observation study was single
centered and double-masked. We studied 239 cases undergoing uneventful
phacoemulsification cataract surgery in the absence of significant ocular
comorbidity. Cases were randomly assigned to 1 of 6 groups receiving the
following treatments: (1) diclofenac (0.1%); (2) pranoprofen (0.1%); (3) control,
physiological normal saline solution; (4) diclofenac (0.1%) and epinephrine; (5)
pranoprofen (0.1%) and epinephrine; (6) control, physiological normal saline and
epinephrine solutions. Pupil diameter was measured at 3 intervals of cataract
surgery: before the first incision, at the end of nucleus fragmentation, and at
the end of cortex irrigation/aspiration.
RESULTS: Compared with patients who were not treated, there was a significant
difference in maintaining pupil dilation throughout the operation when the
patients were treated with either diclofenac or pranoprofen, P<0.001 and P<0.03,
respectively. From the first incision to postnucleus fragmentation, the change in
pupil size in both diclofenac and control groups was significantly associated
with the hardness of the crystalline lens, P=0.001 and P=0.012, respectively. At
the end of irrigation/aspiration, the change in pupil size in only the control
groups was significantly associated with the hardness of the crystalline lens,
P=0.022. Diclofenac treatment was most effective at inhibiting pupil miosis when
the hardness of the nucleus was grade 3, P=0.009. Pupil miosis was not related to
the hardness of the nucleus when the patients were treated with epinephrine.
CONCLUSIONS: Both diclofenac and pranoprofen treatment inhibit surgical-induced
miosis. There is a negative correlation between the hardness of the crystalline
lens and pupil diameter maintenance at the early stage of phacoemulsification.
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