pupil dilation with intracameral lidocaine during phacoemulsification

purpose: to evaluate pupil dilation with intracameral injection of preservative-free lidocaine 1% during phacoemulsification. methods: this interventional case series included 31 consecutive senile cataract patients scheduled for phacoemulsification and intraocular lens (iol) implantation. pupil dilation was achieved using intracameral preservative-free lidocaine 1% without any preoperative or intraoperative mydriatics. pupil diameter was measured by calipers immediately before and 90 seconds after intracameral injection of lidocaine. results: patients included 16 male and 15 female subjects with mean age of 67.3±9.9 years. four patients were diabetic and four cases had pseudoexfoliation. pupil diameter increased from 2.63±0.3 mm preoperatively to 7.03±0.61 mm 90 seconds after intracameral injection of lidocaine with a mean increase of 4.39±0.53 mm (range 3.4-5.2, p<0.001). mean post-injection mydriasis was significantly greater in patients without pseudoexfoliation (7.1 mm vs 6.00 mm, independent t test and mann-whitney test, p<0.01). there was no significant difference between diabetic and non-diabetic patients regarding of pre- and post-injection diameter of the pupil. conclusion: intracameral preservative-free lidocaine 1% provides rapid and effective mydriasis and can be a safe alternative to other topical and intracameral mydriatics used in phacoemulsification.