Efficacy of Intracameral Mydriatics in Pediatric Lens Surgery.

Introduction: The aim of this study was to evaluate the efficacy of intracameral administration of Mydrane® in children undergoing lens surgery.

Methods: We set up a single center prospective cohort trial including 40 consecutive patients between 8 weeks and 17 years old who were planned for lens surgery, including cataract, persistent fetal vasculature or lens subluxation. We injected 0.1 mL of intracameral Mydrane at the beginning of surgery, no preoperative mydriatic eye drops were used. The aim of the study was to measure pupil size and to monitor the evolution of the pupil size during surgery and the need for additional pupil expanding techniques.

Results: In 30 patients (75% [95% CI: 59-87%]), we did not need additional manipulations to obtain sufficient pupillary dilatation to perform the surgery and to implant an intraocular lens following the bag-in-the-lens (BIL) technique. In the remaining 10 patients (25%), we saw an initiation of dilatation but not to the required pupil diameter to continue the surgery without additional surgical maneuvers. The duration of surgery was significantly longer in the partial response group, reflecting the need for additional surgical steps. A significant relation between increase of pupillary diameter and age (p = 0.003), gender (p = 0.032), and horizontal corneal diameter (p < 0.001) could be shown. Even at baseline, there is a larger pupil diameter in eyes with larger horizontal corneal diameters (p = 0.039). No adverse events were observed during this study.

Conclusion: Intracameral administration of Mydrane resulted in some degree of dilatation in all eyes in this series, 75% of eyes did not need additional techniques to proceed with the surgery. Smaller pupils at baseline, younger age, male sex and small horizontal corneal diameter were related to a poorer response to Mydrane. The mydriasis persisted for the entire duration of the surgery, no ocular adverse events were observed during this study. This leads us to conclude that intracameral Mydrane is an effective and safe way to dilate the pupil in pediatric lens surgery.