Controversies in the use of mydriatics

Summary To obtain a good mydriasis is a key step for a safe and efficient cataract surgery. The most common protocols to dilate the pupil before surgery are based on the instillation of several mydriatic eyedrops, usually a mix of parasympatholytic (mostly tropicamide or cyclopentolate) and sympathomimetic (mostly phenylephrine) preparations. This usual regimen is efficient, but presents several disadvantages, including the side effects due to a systemic passage of the drugs, the topical toxicity on the ocular surface, and the time required by the staff to instillate the drops. One emerging alternative is the intracameral injection of the mydriatic drugs, combined with anaesthetics, just before proceeding to the surgery. We will present the results of a multicenter, randomized and controlled study about the use of a standardised intracameral combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% before cataract surgery, compared to a standard eyedrops regimen. The intracameral mix was safe and non‐inferior to the comparator in terms of pupil dilation, with several potential advantages, including less discomfort during surgery and fewer time spent by the patient in the operating theater.