Journal List > J Korean Ophthalmol Soc > v.59(12) > 1109300

Kim, Park, Shin, and Lee: Intracameral Epinephrine Injection after Phacoemulsification on Pupil Dilation during Phacovitrectomy for Proliferative Diabetic Retinopathy



We explored the mydriatic effects of injected intracameral epinephrine after phacoemulsification (PE) combined with phacovitrectomy to treat proliferative diabetic retinopathy (PDR).


We enrolled 96 patients (96 eyes) who underwent phacovitrectomy to treat PDR; we used ImageJ software to measure pupil sizes and the ratios of pupil to cornea area (PCA) before and after PE and after pars plana vitrectomy (PPV). We compared pupil sizes between those who received intracameral epinephrine (0.001% w/v) after PE but before PPV (study group, 46 eyes) and patients not so treated (control group, 50 eyes).


The PCA ratios of the study group were 0.52 ± 0.11 before PE, 0.43 ± 0.12 after PE, and 0.51 ± 0.11 after PPV, respectively. Changes in pupil size were significant (p < 0.001, p < 0.001 respectively). The PCA ratios of the control group were 0.52 ± 0.10 before PE, 0.39 ± 0.15 after PE, and 0.43 ± 0.15 after PPV, respectively. Changes in pupil size after PE were significant (p = 0.011) but the change after PPV was not (p = 0.056).


Intracameral epinephrine given after PE but before PPV effectively dilates the pupils during phacovitrectomy to treat PDR.

Figures and Tables

Figure 1

The ratio of pupil to cornea area (PCA ratio) at different stages of surgery in the two groups. (A) Intracameral epinephrine injection group, (B) control group. The PCA ratio decreased after cataract surgery in both groups but the PCA ratio increased after pars plana vitrectomy in the injection group. OP = operation; PPV =pars plana vitrectomy. *Statistically significant.

Table 1

Baseline characteristics, best-corrected visual acuity (BCVA) and intraocular pressure (IOP) of the two groups


Values are presented as mean ± standard deviation or number.

*Paired t-test.


Conflicts of Interest The authors have no conflicts to disclose.


1. Han SS, Chung EJ. Accuracy of intraocular lens power estimation in eyes undergoing phacovitrectomy for proliferative diabetic retinopathy. J Korean Ophthalmol Soc. 2015; 56:737–744.
2. Choi AY, Yeo Y, Kim YC. Phacovitrectomy versus phacoemulsification after vitrectomy for rhegmatogenous retinal detachment repair. J Korean Ophthalmol Soc. 2015; 56:357–364.
3. Canan H, Sizmaz S, Altan-Yaycioğlu R. Surgical results of combined pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR. Clin Ophthalmol. 2013; 7:1597–1601.
4. Park SP, Ahn JK, Lee GH. Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy. J Cataract Refract Surg. 2009; 35:868–873.
5. Wahab S, Das Hargun L. Combined phacoemulsification, vitrectomy and endolaser photocoagulation in patients with diabetic retinopathy and cataract. J Coll Physicians Surg Pak. 2014; 24:736–739.
6. Yang Y, Zhang J, Yan H. Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study. PLoS One. 2014; 9:e108933.
7. Mirza SA, Alexandridou A, Marshall T, Stavrou P. Surgically induced miosis during phacoemulsification in patients with diabetes mellitus. Eye (Lond). 2003; 17:194–199.
8. Mojumder DK, Patel S, Nugent K, et al. Pupil to limbus ratio: Introducing a simple objective measure using two-box method for measuring early anisocoria and progress of pupillary change in the ICU. J Neurosci Rural Pract. 2015; 6:208–215.
9. Martín-Moro JG, de la, Sanz FG. Conceptual advantages of using pupil to limbus ratio over absolute pupil diameter. J Neurosci Rural Pract. 2015; 6:625–626.
10. Hreidarsson AB. Pupil size in insulin-dependent diabetes. Relationship to duration, metabolic control, and long-term manifestations. Diabetes. 1982; 31(5 Pt 1):442–448.
11. Mirshahi A, Djalilian A, Rafiee F, Namavari A. Topical administration of diclofenac (1%) in the prevention of miosis during vitrectomy. Retina. 2008; 28:1215–1220.
12. Yu AY, Guo H, Wang QM, et al. Pupil dilation with intracameral epinephrine hydrochloride during phacoemulsification and intraocular lens implantation. J Ophthalmol. 2016; 2016:4917659.
13. Huber MJ, Smith SA, Smith SE. Mydriatic drugs for diabetic patients. Br J Ophthalmol. 1985; 69:425–427.
14. Mackool RJ, Muldoon T, Fortier A, Nelson D. Epinephrine-induced cystoid macular edema in aphakic eyes. Arch Ophthalmol. 1977; 95:791–793.
15. Ubuka M, Sugiyama T, Onoda Y, et al. Changes in the blood flow of the optic nerve head induced by different concentrations of epinephrine in intravitreal infusion during vitreous surgery. Invest Ophthalmol Vis Sci. 2014; 55:1625–1629.
16. Labetoulle M, Findl O, Malecaze F, et al. Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery. Br J Ophthalmol. 2016; 100:976–985.
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