Effectiveness of Intracameral Phenylephrine in Achieving Mydriasis and Reducing Complications During Phacoemulsification: A Systematic Review and Meta-Analysis

Abstract

Purpose: To compare the effectiveness of intracameral phenylephrine and topical mydriatics in achieving mydriasis and protecting against complications during phacoemulsification.

Methods: A systematic search of the literature comparing the mydriatic effect and surgical safety profile of intracameral phenylephrine and topical mydriatics in phacoemulsification was conducted in the Medline, Embase, Lilacs, Web of Science, Cochrane, ClinicalTrials.gov , and Teseo databases. The search targeted clinical trials, cohort studies, and case-control studies published between April 20, 2003 and August 14, 2016. Mydriatic effect was assessed by difference in means in pupil of all the patients in the studies [mean difference (MD)] and intraoperative complications were assessed by using inverse-variance weighted odds ratios (ORs), with adjustment for dose. A meta-regression analysis was also conducted, with adjustment for dose, use of epinephrine, tamsulosin use, and type of surgery and type of intraocular lens.

Results: We found 7 articles about mydriatic effect and another 7 about complications. Intracameral phenylephrine achieved a similar mydriatic effect to topical mydriatics, with a difference of less than 10% (MD -0.74 mm, 95% CI: -1.67 to 0.18, I² = 95.8%, P < 0.0001). The pooled OR for complications was OR 0.50, 95% CI: 0.19-1.31, I² = 0.0%, P = 0.670, and posterior capsular rupture was the most common complication in the different studies analyzed.

Conclusion: Intracameral phenylephrine achieves a similar mydriatic effect to topical mydriatics (difference <15%) and is associated with a not-significant effect on reducing the odds of intraoperative complications.

Keywords: cataract; intraoperative complications; meta-analysis; phacoemulsification; phenylephrine; posterior capsular rupture.