Prednisolone and flurbiprofen drops to maintain mydriasis during phacoemulsification cataract surgery

Abstract

Purpose: To compare the effects on the pupil of pretreatment with prednisolone 1% eyedrops, flurbiprofen 0.03% eyedrops, and sodium chloride 0.9% eyedrops in patients having phacoemulsification cataract surgery. Setting: Christopher Home Eye Unit, Royal Albert Edward Infirmary, Wigan, United Kingdom. Methods: One hundred thirty-six white patients having phacoemulsification with no history of eye disease, antiinflammatory medication, or diabetes were enrolled in this prospective randomized double-blind study. Patients were allocated to receive flurbiprofen 0.03%, prednisolone 1%, or sodium chloride 0.9% (placebo) eyedrops at 30-minute intervals beginning 2 hours before surgery. All patients received cyclopentolate 1% and phenylephrine 2.5% drops preoperatively and epinephrine 1:10 6 intraoperatively in the intraocular irrigating solution. The pupil diameter was measured from a television screen at the preset magnification of the operating microscope immediately before the incision, at the end of nucleus emulsification, at the end of irrigation/aspiration (I/A), and at the end of surgery. One hundred twelve patients with a baseline pupil diameter of at least 6.0 mm who had uneventful phacoemulsification were analyzed. Results: The baseline pupil diameters were statistically similar. An analysis of variance did not reveal an overall significant mydriasis-maintaining effect of prednisolone or flurbiprofen compared to the placebo at any stage of surgery ( P = .16 to .37). The 95% confidence interval showed flurbiprofen to be superior to prednisolone at the end of surgery. According to the paired t test, the reduction from the baseline at the end of I/A in the prednisolone group ( P = .051) and at the end of surgery in the flurbiprofen group ( P = .22) was not significant. Conclusion: In the presence of epinephrine in the intraocular irrigating solution, both prednisolone 1% and flurbiprofen 0.03% failed to maintain mydriasis at the crucial steps of nuclear emulsification and cortical I/A.