First Author: T.Bozkurt TURKEY
Co Author(s): A. Bahadir B. Onal B. Karasu H. Bayramlar
Purpose:
To investigate the effect of prednisolone acetate on pupillary dilatation in eyes with poor dilatation history.
Setting:
: Prospective, observational study.
Methods:
Patients who were poorly dilated (?6mm) with tropicamide %1 in regular preoperative cataract identification were dilated with three drops of 10% phenylephrine, 1% tropicamide and cyclopentolate 1% (standard regimen (SR)). Eyes that remained poorly dilated were included in the study (day 1) and these patients were dilated 10 days later (day 10) with SR following administration of three drops of topical prednisolone acetate (PA). Eyes with a history of (1) uveitis, (2) ocular trauma, (3) intraocular surgery and (4) using any topical medication including antiglaucomatous agents were excluded. Pupil size of the all eyes were measured on day 1 and 10 using pupil diameter measuring software of the auto refractokeratometer Canon RK-F1. Pupil diameters and the change in the diameter were evaluated and compared statistically. Eyes were further divided into three groups according to risk factors for poor dilatation; pseudoexfoliation syndrome (PXS), diabetes mellitus and history of alpha adrenergic antagonists usage.
Results:
Of the 270 eyes (148 patients) which were unable to dilate more than 6mm with tropicamide, 69 eyes (44 patients) met the inclusion criteria. Mean age of patients was 67.2 ± 10.1 years. Mean pupil diameter was 5.07 ± 0.58mm (3.50-6.00mm) on day 1 and 5.43 ± 0.6mm (3.50-6.70mm) on day 10. Mean change in pupil size was 0.36 ± 0.26mm. Mean pupil diameter following dilatation after PA administration was statistically higher than the mean pupil diameter with standard regimen. Of the 44 patients, 20 patients (30 eyes) were diagnosed with PXS, 9 patients (16 eyes) were diabetic and 13 patients (23 eyes) had a history of alpha adrenergic antagonist usage for benign prostate hypertrophy. One patient with PXS and additionally using tamsulosin was not included in the statistical analysis of the groups. There was a statistically significant difference between mean changes of pupil size between three groups (p<0.01). In depth analysis, the increase of pupil diameter in patients with PXS was statistically higher than both diabetic patients (p<0.01) and patients with a history of alpha adrenergic antagonists use (p<0.01). On the other hand, no significant difference was found between the latter two groups (p=0.51).
Conclusions:
In this study, prednisolone acetate was found to enhance pupillary dilatation. Thus, adding steroids to preoperative dilatation protocol may be of particular benefit in eyes with poor dilatation. Of note, we think that the higher increase in pupil size in eyes with PXS may be attributable to the pro-inflammatory nature of this syndrome. Therefore, steroids may have an additional benefit in pupil dilatation of PXS patients, most probably due to suppression of the subclinical inflammation.
Financial Disclosure:
None
