Pupil Dilation with Intracameral Lidocaine during Phacoemulsification

To evaluate pupil dilation with intracameral injection of preservative-free lidocaine 1% during phacoemulsification.

This interventional case series included 31 consecutive senile cataract patients scheduled for phacoemulsification and intraocular lens (IOL) implantation. Pupil dilation was achieved using intracameral preservative-free lidocaine 1% without any preoperative or intraoperative mydriatics. Pupil diameter was measured by calipers immediately before and 90 seconds after intracameral injection of lidocaine.

Patients included 16 male and 15 female subjects with mean age of 67.3±9.9 years. Four patients were diabetic and four cases had pseudoexfoliation. Pupil diameter increased from 2.63±0.3 mm preoperatively to 7.03±0.61 mm 90 seconds after intracameral injection of lidocaine with a mean increase of 4.39±0.53 mm (range 3.4-5.2, P<0.001). Mean post-injection mydriasis was significantly greater in patients without pseudoexfoliation (7.1 mm vs 6.00 mm, independent t test and Mann-Whitney test, P<0.01). There was no significant difference between diabetic and non-diabetic patients regarding of pre- and post-injection diameter of the pupil.

Intracameral preservative-free lidocaine 1% provides rapid and effective mydriasis and can be a safe alternative to other topical and intracameral mydriatics used in phacoemulsification.