Eyeworld

EW FEATURE 130 pupil doesn't dilate as widely. Phy- sicians who use this frequently have admitted that it dilates well for the surgery but not quite as well as the drops. Other potential disadvantages include issues involved in the proper mixing of the intracameral injec- tion for dilation and the potential for causing toxic anterior segment syndrome if preserved rather than non-preserved medications are used or if an incorrect dosage of the med- ication is drawn out," Dr. Mamalis said. There is a commercially avail- able intracameral dilating solution in Europe with phenylephrine and lidocaine that may help with pu- pillary dilation for cataract surgery and avoid potential problems with custom mixing of intracameral medications. EW Editors' note: Dr. Cionni has financial interests with Alcon, Ocumetrics (Sur- rey, British Columbia), and ClarVista Medical (Aliso Viejo, California). Drs. Starr and Mamalis have no financial interests related to their comments. Contact information Cionni: 801-266-2283 Starr: cestarr@med.cornell.edu Mamalis: nick.mamalis@hsc.utah.edu Christopher Starr, MD, Weill Cor- nell Medicine, New York Presbyteri- an Hospital, New York. "While this strategy works well for a majority of cases, there are still many instanc- es in which a steady infusion of epinephrine or phenylephrine along with an NSAID would be advanta- geous. Now that we have a commer- cially available product, I would not be surprised to see its use increase in future surveys. With FDA approval of a commercially prepared intraca- meral broad-spectrum antibiotic, I would expect a similar trend in the context of endophthalmitis prophy- laxis." According to Nick Mamalis, MD, John Moran Eye Center, Uni- versity of Utah, Salt Lake City, there are advantages and disadvantages to drops and intracameral injections for dilation. "One advantage of using intracameral injections for di- lation over drops is that fewer drops need to be given. When you are in a busy surgical center and a nurse needs to give 3 or 4 sets of drops prior to surgery, eliminating some of those drops could potentially make it easier for the nursing staff. Anoth- er potential advantage of elimi- nating some of the topical drops is eliminating effects on the corneal epithelium. Lastly, when patients come into the operating room and they are widely dilated, when you first turn on the microscope light, they are very sensitive to the light; if you are dilating them with an intracameral injection, the pupil is still smaller when you initially turn on the microscope, and only then do you dilate them, so they will be a little less sensitive to the microscope light. The disadvantage is that the New continued from page 129 Global Trends in Ophthalmology ™ Copyright © 2016 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. " One advantage of using intracameral injections for dilation over drops is that fewer drops need to be given. When you are in a busy surgical center and a nurse needs to give 3 or 4 sets of drops prior to surgery, eliminating some of those drops could potentially make it easier for the nursing staff. " –Nick Mamalis, MD

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