In this video, we share pearls for achieving pupillary dilatation while peforming cataract surgery in a one eyed patient. This patient was allergic to topical mydriatic eyes drops. Intracameral injection of 0.2 ml of preservative-free lidocaine was attempted as an alternative to mydriatric drops achieving excellent papillary dilatation while performing phaco surgery. An AMO Signature Phacoemulsification Machine was used with Ellips Transverse Fx Ultrasound & Fusion Fluidics. AMO Tecnis IOL implantation was done with post op vision of 20/30.
Cataract surgery requires adequate mydriasis, which is usually achieved by topical and/or intracameral administration of anticholinergic and/or sympathomimetic mydriatic agents, commonly cyclopentolate, tropicamide, phenylephrine and homatropine. These regimens, however, have some disadvantages such as slow onset of dilation, which increases the waiting time before operation, allergic reaction, adverse ocular and systemic effects, which are specially important in high-risk groups such as hypertensive patients and children and their tendencies to wear off during surgery. In our experience injection of 0.2 ml of 1% preservative-free lidocaine (lignocaine) in anterior chamber can have a persistent, stable and satisfactory pupil dilation for a safe phacoemulsification and IOL implantation in different patients including currently shown patient- allergic to topical dilators eye drops, as well as diabetic and non-diabetic and eyes with pseudoexfoliation. Lidocaine is an antiarrhythmic drug as well as an effective local anesthetic. Intracameral injection of preservative-free lidocaine is used widely for local anesthesia and discomfort relief in cataract . Intracameral lidocaine has some advantages over topical mydriatics. It doesn′t need time-consuming preoperative program for pupillary dilation, doesn′t have systemic side-effects of topical mydriatics and provides satisfactory pupillary dilation as well as simultaneous anesthetic effect in phacoemulsification cataract surgery. Intracameral injection of preservative-free lidocaine was attempted as an alternative to reduce the potential disadvantages of common mydriatics. surgery. Lidocaine causes no additional inflammation and endothelial cell loss and its safety has been confirmed in previous studies.
DR. SURESH K PANDEY, MS (PGIMER), ASF (USA)
A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Suresh K Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked at Medical University of South Carolina, Charleston, SC, USA, University of Utah, USA & University of Sydney, Australia from1998 to 2006.
Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Center at Kota, Rajasthan, India (www.suvieye.com). Dr. Pandey has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. Dr. Pandey's book on Pediatric Cataract Surgery (Lippincott Williams & Wilkins, USA) remains the bestseller on this topic. Dr. Pandey had invited to demonstrate Live Surgery at international meeting at Milan, Italy as well as Delhi Ophthalmological Society meetings.
Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology.
Dr Pandey can be reached at Suvi Eye Institute and Lasik Laser Center, C 13 Talwandi, Kota, Rajasthan, India; Phone +91 (744) 2433575; +91 9351412449; E-mail- firstname.lastname@example.org, www.suvieye.com