Does topical flurbiprofen affect the pupillary response to acetylcholine?

Pre-operative topical non-steroidal anti-inflammatory drugs (NSAIDs) are known to be effective in maintaining pupillary dilation during cataract surgery. However, previous studies have suggested that pre-treatment with these agents interferes with the miosis produced by intraoperative acetylcholine injection. This study was designed to determine whether the pupillary response to acetylcholine injection is reduced following pre-operative topical flurbiprofen 0.03%. Pupil diameters were measured with a millimetre rule, and the measurements verified using computerised image analysis of digitised video images. Eyes treated with flurbiprofen were compared with controls. There was no significant difference in pupillary diameter before corneal incision, but following aspiration of soft lens matter and insertion of intraocular lens the pupil was significantly larger in the flurbiprofen group (p = 0.002). At 1.0, 2.5 and 5.0 minutes following injection of acetylcholine no significant difference in the degree of miosis was detected. This study confirms that topical flurbiprofen maintains dilation during cataract surgery, and does not find any evidence to suggest that intra-operative response to acetylcholine is reduced.