Cieľ: porovnať mydriázu pred operáciou katarakty po topickom podaní mydriatík do spojovkového vaku s mydriázou, ktorú sme dosiahli pomocou mydratického roztoku podaného do dolného fornixu na nasiaknutej celulóze. Použité boli tie isté mydriatiká (0,5% tropikamid, 10% fenylefrín, 4% homatropín). Metodika: V prospektívnej nerandomizovanej štúdii sme sledovali arteficiálnu maximálnu mydriázu u 100 pacientov (60 žien, 40 mužov) na 100 očiach pred operáciou katarakty. Priemerný vek pacientov bol 70,17 rokov (42- 91). Pacientov sme rozdelili po 50 do A a B skupiny. V skupine A sme 3x topicky podali v priebehu 10-15 minút do spojovkového vaku 0,5% tropikamid, 10% fenylefrín, 4% homatropín. Pacientom v B skupine sme kvapli 0,4% oxybuprokaín, potom vložili do dolného fornixu asi 30-40 minút pred operáciou nastrihanú celulózu (Kettenbach) nasiaknutú v mydriatickom roztoku a oko zalepili. Mydriatický roztok sme „namiešali“ z 0,5% tropikamidu, 10% fenyefrínu a 4% homatropínu v rovnakom pomere. Na operačnom stole, pred operáciou sme nasiaknutú celulózu odstránili, potom kaliperom pod mikroskopom zmerali horizontálny priemer zrenice na povrchu rohovky a porovnali dosiahnutú predoperačnú šírku zrenice u A a B skupiny pacientov. Zaznamenávali sme aj subjektívne, objektívne obtiaže v oboch skupinách pacientov. Na štatistické porovnanie priemernej mydriázy medzi A a B skupinou pacientov sme použili nepárový Studentov t test. Za štatisticky významné sme považovali p < 0,05. Výsledky: Priemerná mydriáza v A skupine pacientov (mydriatické kvapky topicky) bola 7,84 ± 0,99 (mm). V B skupine pacientov (nastrihaná celulóza nasiaknutá v roztoku mydriatík) bola priemerná mydriáza 7,94 ± 1,03 (mm). Nezaznamenali sme signifikantný rozdiel v diametri zreníc medzi A a B skupinou pacientov (p = 0,622; p > 0,05). V B skupine pacientov sa vyskytli subjektívne aj objektívne obtiaže (pálenie, rezanie, bolesť, erózia rohovkového epitelu), tieto obtiaže spôsobil trojuholníkový tvar a veľkosť nastrihanej celulózy. Záver: Arteficiálna predoperčná mydriáza u pacientov v oboch našich skupinách bola veľmi dobrá. Topická klasicky navodená predoperačná mydriáza má svoje pevné miesto aj v dnešnej modernej chirurgii katarakty, mydriáza pomocou nasiaknutej celulózy môže sestrám šetriť čas.

Aim: To compare mydriasis before the cataract surgery after the local application of mydriatics in to the conjunctival sac with mydriasis achieved using the mydriatic solution in soaked piece of cellulose applied in to the lower fornix. The same mydriatics (tropicamide 0.5 %, phenylephrine 10 %, and homatropine 4 %) were used. Methods: In a prospective, non-randomized study the authors measured maximal artificial mydriasis in 100 patients (60 women, 40 men) in 100 eyes before the cataract surgery. The mean age of the patients was 70.17 years (range, 42 – 91 years). The patients were divided into two groups (A, B), each of 50 persons: In the group A, during the 10 - 15 minutes period, the mydriatics, tropicamide 0.5 %, phenylephrine 10 %, and homatropine 4 %, were topically applied three times. In the patients of the B group, the conjunctival sac was anesthetized by oxybuprocaine 0.4 %; and afterwards, a cut piece of cellulose (Kettenbach) soaked in to the mydriatics solution was applied for 30 – 40 minutes in to the conjunctival sac and the eyelids were taped together. The mydriatic solution was mixed by tropicamide 0.5 %, phenylephrine 10 %, and homatropine 4 %, of equal doses. On the surgery table, before the operation, the soaked cellulose was removed, and thereafter the achieved preoperative horizontal size of the pupil was measured with caliper under the operation microscope. The achieved preoperative pupillary width in the group A and B were compared. The authors noticed also subjective symptoms and objective signs in both groups of patients. For statistical comparison of the average mydriasis between the A and B group of patients, the unpaired Student t test was used. As statistically significant we considered p < 0.05. Results: The average mydriasis in the A group (mydriatic drops topically) was 7.84 ± 0.99 mm. In the B group of patients (cut piece of cellulose soaked in to the mydriatics solution), the average mydriasis was 7.94 ± 1.03 mm. The authors did not found significant difference in the diameters between the A and the B group of patients (p = 0.622; p > 0.05). In the B group of patients, subjective symptoms as well as objective signs appeared (burning sensation, sticking, pain, and corneal epithelium erosion); these problems were caused by the triangle shape and the size of the cut cellulose piece. Conclusion: Artificial preoperative mydriasis in patients in both our groups was very good. Topic classically introduced preoperative mydriasis has its stable place also in contemporary modern cataract surgery; the mydriasis achieved by soaked cellulose may save the nurses’ time.

Očná klinika LF SZU a UNB Nemocnica sv Cyrila a Metoda Bratislava

Comparison of topic mydriasis and mydriasis achieved by soaked cellulose in the conjunctival sac

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