The effect of intracameral adrenaline infusion on pupil size, pulse rate, and blood pressure during phacoemulsification

Abstract

Pupillary constriction during phacoemulsification (phaco) and irrigation/aspiration (I/A) is found to be the major cause of iris damage, incomplete cortex removal, posterior capsule rupture, vitreous loss and even posterior lens material dislocation. Cataract surgery is performed more easily if mydriasis can be maintained. Irrigation fluid containing adrenaline is thought to be of benefit in this respect. We designed a prospective study assessing the efficacy and safety of using perioperative adrenaline during phacoemulsification, as an adjunct to preoperative topical mydriatics. Forty-two cases were randomized to receive intraocular irrigation fluid with or without 1:1,000,000 adrenaline, as a study or control group. Diameter of the pupil, pulse rate, systolic and diastolic pressure before-phaco, after-phaco-before-I/A and after-I/A were measured. All of the operations were performed by the same surgeon with the same technique. The pupil size after-phaco-before-I/A was 8.00 mm in the study group and 5.96 mm in the control group. The mydriasis maintained during phacoemulsification was significantly greater in the study group, p < 0.00001. The pupil size after-I/A was 8.03 mm in the study group, and 5.54 mm in the control group. The mydriasis maintained during I/A was significantly greater in the study group, p < 0.00001. Pulse rate and blood pressure in patients of the study group, even those with hypertension, showed no significant fluctuation during the surgery. We concluded that intraocular irrigation with 1:1,000,000 adrenaline was a safe and effective way of maintaining mydriasis during cataract surgery.