Pupil dilation with intracameral lidocaine during phacoemulsification

Purpose: To evaluate pupil dilation by an intracameral injection of nonpreserved lidocaine 1% during phacoemulsification cataract extraction and compare the results with those using conventional topical mydriatics. Setting: Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Methods: A prospective comparative case series study was conducted. The study included 57 patients who were given topical mydriatics (30 eyes) or intracameral lidocaine (27 eyes) to dilate the pupil for phacoemulsification and intraocular lens implantation. The topical group received 3 drops of cyclopentolate 1% and phenylephrine 5% given 5 minutes apart starting 60 minutes before surgery. The intracameral group received preservative-free lidocaine 1% (0.2 to 0.3 mL) injected just before the procedure began. No epinephrine was added to the irrigating solution. In both groups, the horizontal pupil diameter was measured before and after pupil dilation using the same caliper. Total surgical time, need for a mydriatic agent during the procedure, and subjective surgical performance were recorded. Results: The mean age, sex, cataract density, baseline horizontal pupil diameter, and mean duration of the surgery were the same between the topical group and intracameral group. The mean pupil dilation was 4.52 mm ± 0.08 (SD) in the intracameral group and 4.06 ± 0.09 mm in the topical group; the difference between groups was statistically significant (P = .001). There was no significant difference between groups in the overall subjective surgical performance (P = .74). No patient in the intracameral group and 2 patients in the topical group required an intracameral mydriatic injection. Conclusion: During phacoemulsification, intracameral preservative-free lidocaine 1% provided rapid, effective mydriasis comparable that of topical mydriatics.