Combined Subconjunctival Atropine and Intracameral Epinephrine Injection for Pupil Dilation in Phacoemulsification under Peribulbar Anesthesia

Background: The traditional method of pupil dilation in cataract surgery is topical mydriatics. However, this method has some drawbacks, suggesting the need for other alternatives.
Objective: The aim of the current study is to evaluate a new hybrid regimen for pupil dilation in phacoemulsification.Patients and methods: A prospective randomized controlled contralateral eye study. Under peribulbar anesthesia, bilateral sequential phacoemulsification (with at least a 2-week interval) was performed on conventional cataract cases (40 eyes). The injection group included 20 eyes, in which mydriasis was achieved by a combined subconjunctival 0.6–0.8 mg atropine sulphate and intracameral preserved epinephrine (1:100,000) injection. The topical group included 20 eyes, in which topical tropicamide 1% and phenylephrine 2.5% were used. Dilated pupil diameter (P) was measured using an ophthalmic caliper at four different times: (P1) before corneal incisions, (P2) after corneal incisions (and intracameral epinephrine injection in the injection group), (P3) after ophthalmic viscoelastic device injection, (P4) before intraocular lens implantation, and (P5) at the end of surgery.
Results: (P1) was (4.5 ± 0.61) and (7.7 ± 0.62), (P2) was (7.67 ± 0.64) and (7.54 ± 0.6), (P3) was (7.73 ± 0.64) and (7.68 ± 0.59), (P4) was (7.53 ± 0.6.2) and (7.5 ± 0.59) mm while (P5) was (7.51 ± 0.6) and (7.46± 0.58) mm for the injection and topical groups, respectively. No significant difference existed between both groups except for P1 which was higher in the topical group (p <0.0001).
Conclusion: Combined subconjunctival atropine and intracameral epinephrine is a safe, effective, and practical method for pupil dilation in phacoemulsification when used in conjunction with peribulbar anesthesia.