Use of a mydriatic cocktail with a wick for preoperative mydriasis in cataract surgery: a prospective randomised controlled trial.

PURPOSE: To investigate the efficacy of a standardised wick soaked in a mydriatic cocktail regimen and compare it with the pre-existing regimen of topical dilating drops. DESIGN: Prospective, two armed, randomised, double blind, parallel assignment efficacy study. PARTICIPANTS: In all, 150 eyes of 150 patients were dilated using the dilating cocktail regimen by using a Weck cell sponge. The control group comprised of 75 eyes of 75 patients dilated using the conventional mydriatic regimen. INTERVENTIONS: A specially prepared mydriatic cocktail regimen consisting of 1 : 1 : 1 : 1 ratio of 2.5% phenylephrine, 0.5% moxifloxacin, 1% cyclopentolate, and 0.03% flurbiprofen eye drops was prepared. A standard sized wick (1 cm x 2 mm) made of Weck cell sponge was soaked in the cocktail for a minute and placed in the lower fornix with sterile forceps. In the control group, eyes were dilated with the above drops using topical instillation in every 15 min. The mydriasis was measured at 15, 30, and 45 min after instillation using the Procyon pupillometer under scotopic conditions (0.04 lux). The intraoperative maintenance of mydriasis was measured with calipers after nucleus delivery and after intraocular lens implantation. MAIN OUTCOME MEASURES: Pupillary diameters at the end of 15, 30, and 45 min, and intraoperative maintenance of mydriasis in the two groups were compared using unpaired t-test. RESULTS: There was a statistically significant difference (P<0.001) in dilation achieved at the end of 45 min in both groups. There was also a significant difference of 1-mm dilation between the two groups after nucleus delivery (P< 0.001), and a difference of 1.41 mm after intraocular lens implantation, which was statistically significant (P<0.001). CONCLUSIONS: These results show that the mydriatic cocktail regimen delivered with a wick is a useful, economical, and timesaving regimen compared with the conventional method of preoperative mydriasis using topical drops.

Uveitis following dengue fever.

OBJECTIVE: To report the occurrence of uveitis in patients with prior history of dengue fever. METHODS: A case series of patients with uveitis, presenting with ocular symptoms 3-5 months after contracting dengue fever during the dengue epidemic without any other attributable cause for uveitis. The dengue fever had subsided without any complication. None of the patients had any ocular complication during the acute dengue infection. They were treated on the lines of uveitis with local steroids, cycloplegic, and ocular hypotensive medications, when required, and oral steroid in case of posterior segment involvement. Patients' follow-up varied from 3-5 months. RESULTS: Six patients with serological evidence of prior dengue fever had presented with uveitis not attributable to any other disease. Seven eyes of six patients were affected. Anterior uveitis without any evidence of posterior segment involvement was present in six eyes of five patients whereas one patient had severe vitritis also. The most common symptom was progressive decrease in vision and only three out of seven eyes had evidence of ciliary congestion. All patients promptly responded to the treatment and visual acuity returned to 6/9 or better in five eyes, while 6/24 and 6/18 in other two eyes due to the presence of cataract. None of these patients had recurrence during the follow-up period. CONCLUSION: Uveitis in dengue infection is rare and ophthalmologists should be aware of these delayed ophthalmic complications. The prognosis of post-dengue uveitis is good.

Recruitment of subjects for clinical trials after informed consent: does gender and educational status make a difference?

CONTEXT: Researchers and investigators have argued that getting fully informed written consent may not be possible in the developing countries where illiteracy is widespread. AIMS: To determine the percentage of patients who agree to participate in a trial after receiving either complete or partial information regarding a trial and to find out whether there were gender or educational status-related differences. To assess reasons for consenting or refusing and their depth of understanding of informed consent. SETTINGS AND DESIGN: A simulated clinical trial in two tertiary health care facilities on in-patients. METHODS AND MATERIAL: An informed consent form for a mock clinical trial of a drug was prepared. The detailed / partial procedure was explained to a purposive sample of selected in-patients and their consent was asked for. Patients were asked to free list the reasons for giving or withholding consent. Their depth of understanding was assessed using a questionnaire. Chi-square test was used for statistical analyses. RESULTS: The percentages of those consenting after full disclosure 29/102 (30%) and after partial disclosure 15/50 (30%) were the same. There was a significant (p=0.043) gender difference with a lesser percentage of females (30%) consenting to participation in a trial. Educational status did not alter this percentage. Most patients withheld consent because they did not want to give blood or take a new drug. Understanding of informed consent was poor in those who consented. CONCLUSIONS: The fact that only one-third of subjects are likely to give consent to participate in a trial needs to be considered while planning clinical trials with a large sample size. Gender but not educational status influences the number of subjects consenting for a study. Poor understanding of the elements of informed consent in patients necessitates evolving better methods of implementing consent procedures in India.