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Efficacy and safety of intraoperative use of tropicamide 0.02%/phenylephrine0.31%/lidocaine1% intracameral combination during pediatric cataract surgery

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Abstract

Background

To demonstrate the safety and efficacy of the intracameral use of tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery, a combination widely used in adult patients but still off-label in children.

Methods

Design: two-center, prospective, observational study. Setting: San Giuseppe Hospital, Milan and Meyer Children's Hospital, Florence. Study population: children from 0 to 4 years of age undergoing cataract surgery with or without intraocular IOL implantation, in the absence of clinically significant systemic conditions, history of ocular surgery, concurrent ocular medication, hypersensitivity to any of the substances and post-traumatic cataracts. During the surgery, patients received the combination drug after the primary access to the anterior chamber. Efficacy was evaluated by achieving an adequate mydriasis in order to perform capsulorhexis, while safety was assessed by recording vital signs (heart rate, blood pressure, respiratory rate, temperature) pre- and post-administration of the substance.

Results

This study included 53 surgical procedures of 36 patients: 41 eyes were left aphakic, while 12 eyes received primary IOL implantation. The pupil size was adequate to safely perform capsulorhexis in 52 procedures of 53. The difference in pupil enlargement was significant (6.0 ± 1.14 mm, P =  < 0.001). There were no notable changes in vital parameters.

Conclusions

The administration of intracameral tropicamide 0.02%/phenylephrine 0.31%/lidocaine 1% in pediatric cataract surgery is effective for obtaining an adequate mydriasis without any vital parameters changes throughout the procedure.

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Funding

The authors did not receive any financial support from any public or private sources.

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Authors and Affiliations

  1. Department of Clinical Sciences and Community Health, University Eye Clinic, San Giuseppe Hospital-Multimedica, University of Milan, Via San Vittore 12, 20123, Milan, Italy

    Paolo Nucci, Andrea Lembo & Andrea Dellavalle

  2. Department of Pediatric Ophthalmology, Anna Meyer Children’s University Hospital, Florence, Italy

    Roberto Caputo

  3. Department of Neuroscience, Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Massimiliano Serafino

  4. Department of Health Sciences, University of Genoa, Genoa, Italy

    Irene Schiavetti

  5. Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates

    Francesco Pichi

Authors
  1. Paolo Nucci
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  2. Andrea Lembo
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  4. Andrea Dellavalle
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  5. Massimiliano Serafino
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  7. Francesco Pichi
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Contributions

PN contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AL. The first draft of the manuscript was written by AD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Andrea Lembo.

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Nucci, P., Lembo, A., Caputo, R. et al. Efficacy and safety of intraoperative use of tropicamide 0.02%/phenylephrine0.31%/lidocaine1% intracameral combination during pediatric cataract surgery. Int Ophthalmol 43, 989–995 (2023). https://doi.org/10.1007/s10792-022-02501-4

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  • DOI: https://doi.org/10.1007/s10792-022-02501-4

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