Ventura Bruna Vieira, Rabello Laura Portela, Silvestre Fernanda, Ventura Marcelo Carvalho
Fundação Altino Ventura, Recife, PE, Brazil.
HOPE Hospital de Olhos, Recife, PE, Brazil.
Arq Bras Oftalmol. 2019 Mar-Apr;82(2):111-118. doi: 10.5935/0004-2749.20190025. Epub 2019 Jan 24.
To assess the efficacy of using a nonste-roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification.
This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification.
Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm.
Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.
在比较飞秒激光预处理前的散瞳程度与白内障超声乳化开始时的散瞳程度时，评估术前使用非甾体类抗炎药以及必要时应用再次散瞳技术以最小化瞳孔大小变化的疗效。
这项回顾性研究纳入了使用LenSx（爱尔康实验室公司，得克萨斯州沃思堡）进行白内障手术的患者。采用我们常规的氟比洛芬、托吡卡胺和去氧肾上腺素散瞳方案。对于激光预处理后瞳孔直径小于程控囊切开直径的眼睛应用再次散瞳技术。该技术包括在超声乳化前滴入托吡卡胺和去氧肾上腺素以克服瞳孔收缩。在飞秒激光应用前和超声乳化开始时评估瞳孔大小。
纳入75只眼（70例患者）。9只眼（12%）接受了再次散瞳技术。两个研究手术时间点之间的平均瞳孔直径和平均瞳孔面积无显著差异（分别为p = 0.412和0.437）。总的瞳孔面积收缩为2.4平方毫米。在即将打开伤口进行超声乳化时，没有眼睛的瞳孔直径<5毫米，61只眼（85.3%）的瞳孔直径>6毫米。
在比较激光应用前和超声乳化开始时的测量结果时，术前给予非甾体类抗炎药和再次散瞳技术在飞秒激光预处理的眼中未导致显著的瞳孔大小变化。这种方法可以避免在瞳孔缩小的情况下进行白内障摘除。
