The effect of treatment with topical nonsteroidal anti-inflammatory drugs with and without intraoperative epinephrine on the maintenance of mydriasis during cataract surgery.

The author conducted a six-group, randomized, clinical trial to compare the relative efficacies of use of preoperative topical Ocufen (flurbiprofen), or Indocid (indomethacin, Indocin), with and without concurrent intraoperative epinephrine treatment; epinephrine treatment alone; and placebo in maintaining surgical mydriasis produced by preoperative administration of phenylephrine and cyclopentolate before cataract intraocular lens (IOL) surgery. Two hundred sixteen cases were randomized to receive one of the six treatment combinations. The treatment groups not receiving epinephrine (placebo, Indocid, Ocufen) had average percent decreases in pupil diameter of 19 to 24%, whereas groups receiving epinephrine (with or without Ocufen or Indocid), had decreases of only 0.8 to 2.6%. The effect of epinephrine treatment was significant (P less than 0.0001), regardless of nonsteroidal anti-inflammatory drug (NSAID) treatment. Indocin patients (without epinephrine) had less miosis than placebo patients; the proportion of cases with large decreases in pupil diameter (greater than or equal to 2 mm) was reduced by approximately 50%. Ocufen had an additive effect with epinephrine; the group with Ocufen + epinephrine treatment had a smaller proportion of cases with pupil size decreases than the group with epinephrine alone.