Budget impact analysis of lens material on the posterior capsule opacification (PCO) as a complication after the cataract surgery.

BACKGROUND: Over 300,000 cataract operations are performed in Poland every year, and the most common, late complication of cataract removal surgery is posterior capsule opacification (PCO). The risk of PCO depends on the lens material. Hydrophobic acrylic lenses cause PCO less frequently as lymphatic endothelial cells show lower affinity for the surface of the lens made of silicone. The objective of this study is to assess the economic impact of using hydrophobic acrylic lenses compared to using hydrophilic acrylic lenses for cataract treatment in the Polish inpatient and outpatient settings. METHODS: A budget impact analysis (BIA) compared the economic outcomes associated with using hydrophobic acrylic lenses versus using hydrophilic lenses for patients undergoing cataract surgery. The BIA predicted annual expenses in the following scenarios: performing Nd:YAG to treat PCO within 2 and 3 years after implantation of hydrophobic or hydrophilic acrylic lenses for different lens structure. Data used to assess the frequency of PCO was determined in systematic literature review. Costs of current and predicted interventions were estimated based on average data from 19 Polish hospitals. Prices of health services were taken from official public tariff lists. RESULTS: The use of a hydrophobic lens significantly limits the number of complications after cataract surgery relative to a hydrophilic lens. As hydrophobic lenses have a higher unit price their use increases the cost of treatment which currently is not reflected by adequate difference in price of the service. Total annual National Health Fund (NHF) expenses for 3-year follow-up model range from 139.1 million EUR to 143.1 million EUR depending on the lens structure, due to the cost of complications. CONCLUSIONS: BIA indicates the possibility of introducing surcharge for the use of hydrophobic lenses, which could increase the frequency of their use and reduce the number of complications after cataract surgery. It was estimated that total NHF expenses reach the minimum value for the surcharge at the level of 9 EUR. The surcharge of 14 EUR is the maximum value that does not increase the initial NHF expenses.

Ophthalmic manifestations of atopic dermatitis.

Atopic dermatitis is a chronic condition of complex etiology, whose clinical course involves remission and recurrence. It is not an isolated disease entity affecting only the skin, but one that co-occurs with disorders of other organs. Numerous literature reports have long confirmed the relationship between the disorder and a growing number of ophthalmic manifestations such as keratoconus and retinal detachment. Further studies are required to establish the cause of correlations and to allow for implementation of appropriate prophylaxis and treatment. The aim of the present paper is to review published literature regarding the correlation between atopic dermatitis and ophthalmic manifestations in adults and children.

GWAS links variants in neuronal development and actin remodeling related loci with pseudoexfoliation syndrome without glaucoma.

Pseudoexfoliation syndrome (PEXS) is an age-related elastosis, strongly associated with the development of secondary glaucoma. It is clearly suggested that PEXS has a genetic component, but this has not been extensively studied. Here, a genome-wide association study (GWAS) using a DNA-pooling approach was conducted to explore the potential association of genetic variants with PEXS in a Polish population, including 103 PEXS patients without glaucoma and 106 perfectly (age- and gender-) matched controls. Individual sample TaqMan genotyping was used to validate GWAS-selected single-nucleotide polymorphism (SNP) associations. Multivariate binary logistic regression analysis was applied to develop a prediction model for PEXS. In total, 15 SNPs representing independent PEXS susceptibility loci were selected for further validation in individual samples. For 14 of these variants, significant differences in the allele and genotype frequencies between cases and controls were identified, of which 12 remained significant after Benjamini-Hochberg adjustment. The minor allele of five SNPs was associated with an increased risk of PEXS development, while for nine SNPs, it showed a protective effect. Beyond the known LOXL1 variant rs2165241, nine other SNPs were located within gene regions, including in OR11L1, CD80, TNIK, CADM2, SORBS2, RNF180, FGF14, FMN1, and RBFOX1 genes. None of these associations with PEXS has previously been reported. Selected SNPs were found to explain nearly 69% of the total risk of PEXS development. The overall risk prediction accuracy for PEXS, expressed by the area under the ROC curve (AUC) value, increased by 0.218, from 0.672 for LOXL1 rs2165241 alone to 0.89 when seven additional SNPs were included in the proposed 8-SNP prediction model. In conclusion, several new susceptibility loci for PEXS without glaucoma suggested that neuronal development and actin remodeling are potentially involved in either PEXS onset or inhibition or delay of its conversion to glaucoma.

Choroidal infarction in a glaucoma patient with Flammer syndrome: a case report with a long term follow-up.

BACKGROUND: We present a long term follow-up of a young female patient with choroidal infarction, primary open angle glaucoma and Flammer syndrome. The patient had no classical risk factors for vascular occlusions, except for the presence of Flammer syndrome. The essential feature of this syndrome is primary vascular dysregulation, sometimes including vasospasm. The vessels of affected people respond more intensely to a number of stimuli, such as coldness or emotional stress. Any organ can be involved, including parts of the eye. The dense autonomic innervation of the choroidal vessels predisposes them particularly to vasospasms. CASE PRESENTATION: The patient was originally referred to our centre because of a deep unilateral paracentral scotoma with the presumptive diagnosis of a normal tension glaucoma. The discrepancy between the visual field defect and the optic nerve head morphology, however, led us to a vascular evaluation by a simultaneous fluorescein/indocyanine green angiography. This revealed an antecedent choroidal infarction that explained the visual field scotoma and the retinal nerve fibre layer defect in the corresponding area. During the follow-up period of 11 years, the patient also developed bilateral glaucomatous optic neuropathy despite a well-controlled intraocular pressure. CONCLUSIONS: We hypothesise that in the patient presented here, the Flammer syndrome contributed to both the acute unilateral choroidal infarction and to the chronic development of bilateral glaucomatous optic neuropathy.

Uveal effusion syndrome ­ a case study. / Zespól wysiekowo-naczyniówkowy ­ opis przypadku.

We report a case study of a 63-year-old female admitted to our department with substantially decreased vision in her right eye. Bilateral uveal effusion syndrome concomitant with nanophthalmos was diagnosed. The patient received systemic treatment with non-steroidal anti-inflammatory drugs and underwent sclerectomy with topical application of mitomicin C. Gradual resolution of the retinal detachment leading to full reattachment was observed over the next 2 months. Retinal detachment did not reoccur in a long-term follow up.

Perioperative endophthalmitis prevention in cataract surgery in Mazovia and Greater Poland in 2013 and 2014. / [Profilaktyka okolooperacyjna w chirurgii zacmy w województwach mazowieckim i wielkopolskim w latach 2013 i 2014].

Aim: This is the first overview of practice patterns in endophthalmitis prevention after cataract surgery in Poland. Material and methods: The study is based on a survey carried out in 33 centres performing cataract surgery in two provinces of Poland (a total of 8.8 million inhabitants, i.e. 23% of the entire country population). Approximately 39.000 cataract surgery procedures are performed in these regions annually, i.e. 20% of all cataract surgery procedures in Poland. The questionnaire-based survey focused on the following aspects: duration of preoperative antibiotic treatment, type of antiseptics, intraoperative administration of antibiotics and duration of postoperative antibiotic treatment. Results: All surveyed centres use povidone-iodine as antiseptic on the periocular skin and conjunctival sac, and perioperative topical antibiotics are adopted by most. Intracameral cefuroxime is increasingly used in endophthalmitis prevention. Conclusion: The methods of endophthalmitis prevention vary widely between ophthalmology departments and clinics in Poland, there is no scientific rationale for most preventive measures used and a further debate is needed among Polish ophthalmic surgeons on optimal practice patterns.

The opinion of the Expert Group of the Polish Society of Ophthalmology on using nepafenac in the prevention of postoperative macular edema after cataract surgery in diabetic patients.

Nepafenac is an innovative non-steroidal anti-inflammatory drug used in ophthalmology for the prevention of macular edema after cataract surgery. Along with its anti-inflammatory effect, nepafenac has some unique properties which distinguish it from other non-steroidal anti-inflammatory drugs. It is a prodrug activated to amfenac after it penetrates through the corneal layers to the aqueous humour and the ciliary body. Having electrically neutral molecules of lipophilic properties, nepafenac does not accumulate in the cornea and does not cause its degeneration. Additionally, it quickly achieves higher concentrations in the aqueous humour as compared to other non-steroidal anti-inflammatory drugs. Nepafenac shows high selectivity and activity against COX-2 isoform, the key enzyme implicated in inducing inflammation, which is the main cause of macular edema. Furthermore, nepafenac has the unique scleral and suprachoroidal distribution pathways. Finally, its effect on the intraocular pressure is none to negligible. Nepafenac treatment should be initiated prior to cataract surgery and continued long enough to reduce the risk of late-onset macular edema. The Expert Group of the Polish Society of Ophthalmology consider using nepafenac in the prevention of post­operative macular edema in diabetic patients undergoing cataract surgery as expedient and reasonable. The proposed optimum pre- and postoperative treatment regimen can be modified for individualised therapy.

Decreased endothelin-1 plasma levels in multiple sclerosis patients: a possible factor of vascular dysregulation?

BACKGROUND: Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system with possible involvement of vascular dysregulation secondary to endothelial dysfunction caused by destruction of the vessel wall. Vascular dysregulation leads to excessive vasoconstriction or insufficient vasodilatation, resulting in vasospasm mediated by endothelin-1 (ET-1), the most potent and long-lasting mediator. Vascular dysregulation can play an important role in the pathogenesis of some eye disorders and it has been hypothesized that it is a vascular risk factor for glaucomatous optic neuropathy. The aim of this study was to estimate endothelin-1 (ET-1) plasma levels in patients with MS. MATERIAL AND METHODS: The MS group consisted of 39 patients (9 males, 30 females), mean age: 38.8 ± 10.02 years, range: 22-62. The control group consisted of 27 healthy volunteers (3 males and 24 females), mean age: 37.4 ± 10.88 years, range: 20-62; clinically, in a non-active stage of the disease. ET-1 plasma levels were measured using the Endothelin-1 ELISA Kit (Immuno-Biological Laboratories Co., Japan). Statistical analysis was performed with the nonparametric Mann-Whitney U test for independent groups. RESULTS: Endothelin-1 (ET-1) plasma levels were significantly lower in MS patients compared to healthy controls: mean value 0.55 ± 0.44 pg/ml (146.05 ± 118.27 fmol/ml) vs. 0.95 ± 0.48 pg/ml (252.83 ± 127.16 fmol/ml); P=0.012. CONCLUSIONS: Significantly decreased ET-1 plasma levels in the MS patients could reflect the non-active disease at the time of ET-1 measurements or the effects of immunomodulatory treatment, but it cannot be excluded that decreased ET-1 plasma levels in these patients might result from vascular dysregulation.

Levels of antibodies against human heat shock protein (HSP) 60 in patients with glaucoma in Poland.

BACKGROUND: Although elevated intraocular pressure is a major risk factor for the development of glaucoma, there is increasing evidence that the immune system may be involved in the development of normal-tension glaucoma (NTG). The aim of this study was to determine if NTG is associated with elevated levels of antibodies against human heat shock protein (HSP) 60. MATERIAL AND METHODS: The study was conducted in 139 subjects (35 subjects with NTG [Group 1], 34 subjects with primary open-angle glaucoma /POAG/ [Group 2], 24 subjects with autoimmune rheumatic diseases [Group 3], and 36 healthy controls [Group 4]). All subjects had complete ophthalmologic examination (visual acuity, slit-lamp examination, tonometry, gonioscopy; visual-field examination, and optical coherence tomography /OCT/ of the optic nerve head and the macula). Blood samples were collected for the measurements of serum levels of antibodies against human HSP60. RESULTS: The subjects with rheumatic diseases had the highest median serum level of antibodies against HSP60 - 20.49 ng/mL. The values in the subjects with NTG, POAG, and in controls were 18.79 ng/mL, 18.61 ng/mL and 17.61 ng/mL, respectively (p=0.96). CONCLUSIONS: This study does not confirm the hypothesis that normal-tension glaucoma is associated with elevated blood levels of antibodies against human heat shock protein (HSP) 60.

[Orbital cellulitis with concomitant bacteraemia (Stenotrophomonas maltophilia) as a complication of an intraorbital foreign body--a case report and literature review]. / Zapalenie tkanek oczodolu z towarzyszaca mu bakteriemia (Stenotrophomonas maltophilia) jako powiklanie wewnatrzoczodolowego ciala obcego--opis przypadku i przeglad pismiennictwa.

This is a case report of a 53-year-old man, who presented in the Department of Ophthalmology with signs of orbital cellulitis on the right side, which developed over a few days following an injury. Computed tomography revealed inflammatory infiltration of the orbital soft tissues, penetrating to the sella turcica. Orbital swab and blood cultures revealed the presence of Enterobacter and Peptostreptococcus spp. as well as Stenotrophomonas maltophilia, respectively. Review of the literature relevant to the presented case was performed based on the PubMed databasesearch, using the following keywords: intraorbital foreign body, orbital cellulitis, neuroinfection, Stenotrophomonas maltophiia.. Summarizing, the orbital injury-associated infections can be potentially life-threatening, due to the proximity of the anterior cranial fossa. Hence, they require prompt diagnosis and intensive treatment.

[Atypical case of acute retinal necrosis secondary to the primary herpes simplex infection]. / Nietypowy przypadek ostrej martwicy siatkówki w przebiegu pierwotnego zakazenia wirusem herpes simplex.

Acute retinal necrosis is a rare manifestation of viral chorioretinitis, accompanied by occlusive vasculitis, which is associated with poor visual prognosis. The main causal factors include varicella-zoster virus in older patients and herpes simplex in younger ones. The disease typically manifests as a reactivation of latent infections. We present a case of a 57-year-old female with atypical clinical manifestation of acute retinal necrosis secondary to the primary viral infection with herpes simplex. The serology panel of vitreous tap and blood sample confirmed viral aetiology (H. simplex). The initial clinical signs included optic disc edema with retinitis presenting as self-limiting, slowly progressing, peripheral lesions, later followed by uveitis. The antiviral therapy resolved the symptoms of uveitis and enabled healing of retinal lesions, however the natural course of disease was later complicated with retinal detachment. It was successfully treated with vitreoretinal surgery. Despite aggressive treatment, the final visual outcome was unfavourable, due to optic nerve atrophy.

Endocyclophotodestruction in glaucoma patients undergoing combined surgery of pars plana vitrectomy and phacoemulsification.

BACKGROUND: The purpose of this trail was to assess the effect of a novel intraoperative endocyclophotodestruction method on intraocular pressure in patients undergoing combined procedure of phacovitrectomy to determine the efficacy of this combined surgical approach. MATERIAL AND METHODS: The study sample included 87 subjects divided into 2 groups: Group I consisted of 52 patients who underwent intraoperative endocyclophotodestruction performed during phacovitrectomy. Group II consisted of 35 controls. The follow-up duration was 12 months. The preoperative (baseline) intraocular pressure (IOP) was determined and later assessed postoperatively at the following time points: on 1 day and at 1, 2, 3, 6, and 12 months. Other evaluated parameters were the number of topical antiglaucoma medications, and the cyclophotodestruction circumference-to-outflow resistance ratio (R). RESULTS: The mean postoperative reduction of intraocular pressure was by 4.26 mmHg at 6 months and by 4.91 mmHg at 12 months. The number of topical antiglaucoma medications was reduced postoperatively from the mean preoperative value of 1.66 to 0.69 at 6 months and 1.04 at 12 months. CONCLUSIONS: The results show a significant reduction of intraocular pressure in patients undergoing the combined triple-procedure surgery and postoperative decrease in the number of topical medications. The best outcomes in terms of IOP decrease and reduced number of medications were achieved in patients with low outflow coefficient. Endocyclophotodestruction is an alternative IOP-reducing technique to be used in patients with glaucoma who require phacovitrectomy. It is recommended for patients with low outflow coefficient in whom posterior pole abnormalities constitute the main indications for surgery.

Selected autoantibodies and normal-tension glaucoma.

BACKGROUND: Although intraocular pressure is an important risk factor in glaucoma, there is growing body evidence indicating an immunological component in the pathogenesis of normal-tension glaucoma (NTG). The aim of this study was to determine if NTG coexists with elevated levels of autoantibodies detected in rheumatic diseases. MATERIAL AND METHODS: We enrolled 105 patients into the study: 35 with NTG, 34 with primary open-angle glaucoma (POAG), and 36 controls. All patients underwent ophthalmic examination and blood tests. Blood was examined for the level of: antibodies against antinuclear antibodies (ANA), antibodies to extractable nuclear antigens (ENA), immunoglobulins (IgG, IgA, IgM), rheumatoid factor, anti-citrullinated protein antibodies (ACPA), and antiphospholipid antibodies (anticardiolipin antibodies, beta2-glycoprotein I antibodies, antiprothrombin antibodies). RESULTS: The level of ANA was increased among 6 patients in the NTG group (17.1%), 8 in the POAG group (23.5%), and 6 in the control group (16.5%). The difference was not statistically significant (p=0.97). None of the patients in the NTG, POAG, or control group had positive antibodies to ENA. The level of immunoglobulins IgG, IgM, and IgA in the 3 groups was similar and within normal values. The median level of rheumatoid factor and ACPA was the highest in the NTG group, but it was within normal laboratory values. There was a statistically significant difference between antiprothrombin antibodies IgG between the NTG and POAG group (p=0.01), but not between the NTG and control group (p=0.24). CONCLUSIONS: The results of our study do not confirm the hypothesis that NTG coexists with elevated blood levels of antibodies, which are a characteristic feature of rheumatic diseases.

The efficacy of bevacizumab in diabetic macular oedema in a 12-month follow-up.

PURPOSE: To evaluate visual acuity and anatomic response of the macula following intravitreal bevacizumab injections in diabetic macular oedema. MATERIAL AND METHODS: In the retrospective, non-randomised study 35 eyes of 28 subjects (whose mean age was 59.6 years) with focal or diffuse diabetic macular oedema were included. Patients underwent best corrected visual acuity testing with Snellen charts converted to a number of letters, intraocular pressure measurement, slit lamp examination, macular biomicroscopy, central macular thickness measurement by optical coherence tomography as well as fluorescein angiography at baseline and all follow-up visits. Patients were treated with one or two intravitreal injections of 1.25 mg of bevacizumab. RESULTS: A total of 49 intravitreal injections were performed. All patients had a 6-12-month follow-up after the first injection. The mean baseline best-corrected visual acuity was 5.0 ± 4.3 letters and the mean central macular thickness in the baseline optical coherence tomography was 482.0 ± 109.7 µm. An improvement in the mean best-corrected visual acuity (6.2 ± 6.3, p = 0.020) and central macular thickness (426.8 ± 131.7 µm, p = 0.010) was statistically significant during the follow-up after first injection. There was no statistically significant difference in the best-corrected visual acuity (6.2 ± 6.5, p = 0.055) and central macular thickness (461.2 ± 148.3 µm, p 0.200) after the second injection. There was no correlation between the best corrected visual acuity and central macular thickness. No serious adverse events were observed. CONCLUSIONS: Intravitreal bevacizumab injections significantly improve visual acuity and decrease central macular thickness in patients with diabetic macular edema. This treatment is safe for patients but the therapeutic effect is temporary.

Multifocal syphilitic chorioretinitis--a case report.

The aim of the paper is to report a case of a 22-year-old male patient with chronic bilateral uveitis and retinitis secondary to syphilis. Until the diagnosis, the patient had been treated symptomatically with ceftriaxone which resulted in visual acuity improvement. The patient was referred to the Sexually Transmitted Disease Clinic for causal treatment after which he did not continue further ophthalmic monitoring. After a year he contacted the Department again due to vision deterioration and a relapse of retinitis and choroiditis was diagnosed. The patient was referred to the Sexually Transmitted Disease Clinic for causal treatment which he never received as he did not present there. Since the beginning of the 21st century the incidence of syphilis has significantly increased. Although it is an infectious disease with potentially permanently debilitating effect e.g. on vision, its treatment is not compulsory in Poland. Infectious etiology and primary syphilis should always be considered in patients with progressive retinitis, choroiditis and vitritis.

Applicability of standard parameters in diagnostics of primary open-angle glaucoma.

BACKGROUND: The aim of this study was to evaluate the sensitivity, specificity, and likelihood ratio of standard diagnostic parameters C/D, NFI, and MD and their applicability in diagnostics of primary open-angle glaucoma. MATERIAL AND METHODS: This study included 194 subjects (371 eyes), ages 30 to 65 years old, who underwent full ophthalmologic examination and HRT, GDx, and FDT examinations. The values of C/D, NFI, and MD diagnostic parameters were determined. The data were statistically evaluated to determine their sensitivity, specificity, and likelihood ratio. RESULTS: Values of the positive and negative likelihood ratios were C/D (11.471 and 0.159), NFI (3.739 and 0.152), and MD (6.323 and 0.309), respectively. CONCLUSIONS: The C/D parameter showed the highest sensitivity and specificity, as well as high positive likelihood ratio and near-zero negative likelihood ratio. The NFI and MD parameters showed lower likelihood ratios and their applicability for the diagnosis of primary open-angle glaucoma is limited.

[Collagen based dressings in the treatment of wound healing]. / Opatrunki kolagenowe w gojeniu ran.

Collagen is the fundamental protein forming the connective tissues matrix, improves the ability of keratinocytes to migrate to sites that require rebuilding of the damaged epidermis, is one of the component of dressings used to accelerate wound healing. Because of the potential risk of the presence of pathogenic prions in bovine collagen, part of collagen dressings is formed on the basis of porcine collagen. Currently, a least of an immunogenic form of collagen is atelocollagen, which is subjected to enzyme-treated collagen, in which the terminal amino acids are removed from the collagen. It is assumed that in the near future atelocollagen will be used also as a carrier for drugs which support the healing processes.

The reliability and applicability of a macular thickness measurement in the diagnostic evaluation of primary open angle glaucoma.

AIM: The aim of the study was to evaluate the sensitivity and specificity of retinal thickness measurements in the macular region and the applicability of this method in the diagnosis of primary open-angle glaucoma. MATERIAL AND METHODS: A group of 194 subjects (371 eyes) aged 30 to 65 years underwent a comprehensive ophthalmic examination including the macular thickness measurement using the rerinal thickness, analyzer. The following parameters were determined: foveolar average thickness foveal average thickness, perifoveal average thickness and posterior pole average thickness. The data was analyzed statistically in order to determine the sensitivity, specificity and the likelihood ratio for the measurement method. RESULTS: We found the following positive and negative likelihood ratio values for the respective interest areas: foveolar average thickness (2.374 and 0.456), foveal average thickness (2.501 and 0.482), perifoveal average thickness (6.161 and 0.099) and posterior pole average thickness (6.019 and 0.124). CONCLUSION: For the perifoveal and posterior pole regions, the method of retinal thickness measurement showed a high sensitivity and specificity as well as a high positive likelihood ratio and a near-zero negative likelihood ratio. The retinal thickness measurements can therefore be successfully applied in the diagnosis of primary open-angle glaucoma.

First Nation-Wide Study of the Incidence and Characteristics of Retinal Detachment in Poland during 2013-2019.

AIMS: The present study aimed to analyze the incidence and characteristics of all types of retinal detachment (RD) in the overall population of Polish adults during 2013-2019. METHODS: Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify RD patients and RD treatment procedures. RESULTS: In the period 2013-2019, 71,073 patients with RD were newly diagnosed in Poland. The average incidence was 32.64/100,000 person-years (95% CI: 31.28-33.99) and it increased with the age of patients, with the highest rate in the group of patients ≥70 years of age. The overall incidences of rhegmatogenous RD, traction RD, serous RD, other RD and unspecified RD were 13.72/100,000, 2.03/100,000, 1.02/100,000, 7.90/100,000 and 7.97/100,000 person-years, respectively. The most common surgical treatment for RD in Poland was PPV performed on average in 49.80% of RD patients. The risk factor analyses showed that rhegmatogenous RD was significantly associated with age (OR 1.026), male sex (OR 2.320), rural residence (OR 0.958), DM type 2 (OR 1.603), any DR (OR 2.109), myopia (OR 2.997), glaucoma (OR 2.169) and uveitis (OR 2.561). Traction RD was also significantly associated with age (OR 1.013) and male sex (OR 2.785) as well as with any DR (OR 2.493), myopia (OR 2.255), glaucoma (OR 1.904) and uveitis (OR 4.214). Serous RD was significantly associated with all analyzed risk factors except DM type 2. CONCLUSIONS: The total incidence of retinal detachment in Poland was higher than found in previously published studies. Our study demonstrated that diabetes type 1 and diabetic retinopathy are risk factors of development of serous RD, which is presumably associated with the disruption of the blood-retinal barriers in these conditions.

Pupil diameter during cataract surgery after intracameral injection of the first ready-to-use combination of mydriatics and anaesthetic at the beginning of surgery in patients with a preoperative pupil diameter <6 mm.

PURPOSE: We evaluated, in a real-life setting, the effect of Mydrane® (ready-to-use combination of tropicamide, phenylephrine hydrochloride and lidocaine, injected into the anterior chamber at the beginning of cataract surgery to induce mydriasis and intraocular anaesthesia) on the pupil diameter during cataract surgery in patients with a preoperative pupil diameter <6 mm after the use of topical mydriatics. METHODS: We collected and analysed the data of 59 consecutive patients whose pupils dilated to a diameter <6 mm after the administration of mydriatic eye drops during the preoperative visit and who received Mydrane® during cataract surgery. RESULTS: In the group of 59 patients with a preoperative pupil diameter <6 mm after topical mydriatics, cataract surgery was performed in 36 patients (61.0%) using only Mydrane® to obtain mydriasis, with no additional drug or medical device. The mean pupil diameters in this group (36 of 59) during the preoperative assessment after topical mydriatics and just before capsulorhexis when Mydrane® was injected during surgery were 5.1 ± 0.74 and 6.15 ± 1.14 mm. Additional drugs were used in 23 patients (39%). In this group, the mean pupil diameters after topical mydriatics and just before capsulorhexis using Mydrane® were 4.58 ± 1.06 and 5.6 ± 1.26 mm, respectively. CONCLUSION: In a real-life setting, the mean pupil diameter achieved during cataract surgery after the intracameral injection of Mydrane® in patients with a preoperative pupil diameter <6 mm was over 1 mm larger than the mean pupil diameter after topical mydriatics, despite the trauma caused by the operation.