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Letters to the Editor

Pre-operative use of the topical steroidal and non-steroidal anti-inflammatory agents to maintain intra-operative mydriasis during cataract surgery

Joshi, Rajesh Subhash

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Indian Journal of Ophthalmology: May 2013 - Volume 61 - Issue 5 - p 246-247
doi: 10.4103/0301-4738.113322
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Dear Editor,

I read with interest an article by Lira et al. on pre-operative use of prednisolone and non-steroidal anti-inflammatory agents to maintain mydriasis during phacoemulsification of the cataract.[1]

I congratulate the authors for documenting the role of pre-operative use of 1% prednisolone eye drops to maintain the pupillary dilatation.

In the era of phacoemulsification, the handling of the intraocular tissue is very minimal. Mydriasis during the surgery is maintained by the continuous irrigation of the balanced salt solution and the use of viscoelastic due to closed anterior chamber. Even if the pupil becomes small we can inject intracameral 1% lignocaine, which helps in the dilatation of the pupil. The safety of the intracameral use of 1% lignocaine during phacoemulsification has been proved in various studies.[234] Maresova et al. has shown phacoemulsification can be done without putting pre-operative mydriatic drops or any steroidal or non-steroidal anti-inflammatory agents.[5] Do we need pre-operative use of steroidal or non-steroidal anti-inflammatory agents to maintain the mydriasis during the phacoemulsification of uncomplicated cataract? Why authors preferred to instill drops 48 h before performing phacoemulsification of the cataract?

I feel the authors should have studied the effect of prednisolone eye drops on the normal conjunctival flora.

1. Zanetti FR, Fulco EA, Chaves FR, da Costa Pinto AP, Arieta CE, Lira RP. Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial Indian J Ophthalmol. 2012;60:277–81
2. Shah AR, Diwan RP, Vasavada AR, Keng MQ. Corneal endothelial safety of intracameral preservative-free 1% xylocaine Indian J Ophthalmol. 2004;52:133–8
3. Gupta SK, Kumar A, Agarwal S. Cataract surgery under topical anesthesia using 2% lignocaine jelly and intracameral lignocaine: Is manual small incision cataract surgery comparable to clear corneal phacoemulsification? Indian J Ophthalmol. 2010;58:537–40
4. Gillow T, Scotcher SM, Deutsch J, While A, Quinlan MP. Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia Ophthalmology. 1999;106:2173–7
5. Maresová K, Procházková J. Cataract surgery without preoperative mydriasis Cesk Slov Oftalmol. 2009;65:16–8
© 2013 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow