Comparative study of mydriasis in cataract surgery: topical versus Mydriasert versus intracameral mydriasis in cataract surgery

PURPOSE. To compare the mydriatic efficacy and cardiovascular safety of the mydriatic options. METHODS. This was a prospective randomized analysis of 90 eyes submitted to senile cataract surgery. Group A (30 eyes) included topical mydriasis, group B (30 eyes) included mydriasis with the ophthalmic insert (Mydriasert), and group C (30 eyes) included intracameral mydriasis. Measures were mydriasis value before ophthalmic viscoelastic device (OVD) injection and at the end of surgery, blood pressure and heart rate, need for antihypertensive medication, and subjective iris stability. RESULTS. Before OVD injection and at the end of surgery, pupillary dilation was 8.1 and 7.0 mm in group A, 8.2 and 7.7 mm in group B, and 6.3 and 6.1 mm in group C, respectively. Mean surgery time was 8.3 min in group A, 8.1 min in group B, and 12.3 min in group C (p<0.05). The mean subjective iris stability score was 8.7/10 in group A, 9.3/10 in group B, and 6.1/10 in group C (p<0.05). Systolic blood pressure was greater than 180 mmHg in 9 (30%) patients in group A, 3 (10%) in group B, and 2 (6.6%) in group C. Antihypertensive medication was administered to 8 (26.6%) cases in group A, 2 (6.6%) in group B, and 0 (0%) in group C (p<0.05). CONCLUSIONS. The most effective mydriasis was obtained within the Mydriasert group, followed by the topical mydriasis group. From the cardiovascular point of view, intracameral mydriasis was the safest and topical mydriasis the least safe.