Cataract surgery is performed more easily if
mydriasis can be maintained until the
intraocular lens has been inserted. Intraocular irrigation with
adrenaline is thought to be of benefit in this respect, and is used by some surgeons but not others. This prospective double blind controlled trial assessed the efficacy and safety of using perioperative
adrenaline during extracapsular
cataract surgery, as an adjunct to preoperative topical
mydriatics. Seventy patients were randomised to receive intraocular irrigation fluid with or without 1:1,000,000
adrenaline. The
adrenaline entering the eye through the anterior capsulotomy needle helped to resist the
miosis induced by expression of the nucleus (7.1 versus 6.5 mm). The
mydriasis maintained during irrigation aspiration was significantly greater in the group receiving
adrenaline (6.6 versus 6.0 mm, p < 0.02). Their pupil diameters were also significantly larger at 20 minutes (p < 0.001) and 30 minutes (p < 0.01) into surgery. Pupillary constriction to a diameter of less than 5 mm occurred more frequently in the group not receiving
adrenaline. Pulse rate and blood pressure in the 27 patients who had local anaesthesia showed no significant difference between the treatment groups (p > 0.05), and there was no significant variation from baseline (p > 0.05). Intraocular irrigation with
adrenaline 1:1,000,000 is a safe and effective means of maintaining
mydriasis during
cataract surgery.