Pre-operative use of the topical steroidal and non-steroidal anti-inflammatory agents to maintain intra-operative mydriasis during cataract surgery.

Dear Editor,

I read with interest an article by Lira et al. on pre-operative use of prednisolone and non-steroidal anti-inflammatory agents to maintain mydriasis during phacoemulsification of the cataract.[1]

I congratulate the authors for documenting the role of pre-operative use of 1% prednisolone eye drops to maintain the pupillary dilatation.

In the era of phacoemulsification, the handling of the intraocular tissue is very minimal. Mydriasis during the surgery is maintained by the continuous irrigation of the balanced salt solution and the use of viscoelastic due to closed anterior chamber. Even if the pupil becomes small we can inject intracameral 1% lignocaine, which helps in the dilatation of the pupil. The safety of the intracameral use of 1% lignocaine during phacoemulsification has been proved in various studies.[234] Maresova et al. has shown phacoemulsification can be done without putting pre-operative mydriatic drops or any steroidal or non-steroidal anti-inflammatory agents.[5] Do we need pre-operative use of steroidal or non-steroidal anti-inflammatory agents to maintain the mydriasis during the phacoemulsification of uncomplicated cataract? Why authors preferred to instill drops 48 h before performing phacoemulsification of the cataract?

I feel the authors should have studied the effect of prednisolone eye drops on the normal conjunctival flora.