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Tropicamide 1% as single agent mydriatic for preoperative cataract assessment

Poster Details

First Author: D.Roberts UK

Co Author(s):    S. Gillan   J. Nair                 

Abstract Details


Standard preoperative cataract assessment in Ninewells Hospital involves use of 1 drop of Tropicamide 1% in all patients for pupil dilation. Pupil dilation on the day of surgery involves using 3 doses of Cyclopentolate 1% and Phenyephrine 2.5%. A prospective analysis was conducted to compare the difference in pupil size noted pre and intraoperatively to assess the outcomes.


Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, United Kingdom, DD19SY


38 patients with either small or mid-dilated pupils at a dedicated cataract assessment clinic were followed prospectively. Pupil sizes in these patients were then noted on the operating table by the operating surgeon. Additional measures used for optimising intraoperative mydriasis including intracameral phenylephrine and iris hooks were recorded.


15 patients had small pupils and 23 had mid-dilated pupils at initial assessment. Of the 15 patients with small pupils pre-operatively 3 patients still had pupil size regarded as small and needed intra-operative iris hooks. Of the remainder, 5 had dilated fully and 7 were mid-dilated. 3 of these patients had previously been on alpha receptor antagonists. Of the 23 patients with mid-dilated pupils pre-operatively 18 were fully dilated on the day of their operation and 5 remained mid dilated. None of these patient in this group required iris hooks, however intracameral phenylephrine was used in 6 patients (16 %).


The use of Tropicamide 1% as a single agent for preoperative pupil size assessment does not appear to allow accurate prediction of intraoperative pupil size. However in this analysis patients with small pupils pre-operatively were more likely to remain small on the operating table and require pupil stretching (20 % of this group) despite the use of Cyclopentolate and phenylephrine. Using a combination of Cyclopentolate 1% and phenylephrine 2.5% at initial assessment may allow more efficient allocation of patients to appropriate surgical lists and more accurate prediction of intraoperative pupil size.

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