Abstract
BACKGROUND This study aimed to compare the safety and efficacy of phacoemulsification performed using topical cyclopentolate (Cykloftyal) vs standard intracameral mydriatic and anesthetic combination (Mydrane) in patients undergoing implantation of enhanced monofocal intraocular lenses. MATERIAL AND METHODS The medical records of 100 patients (100 eyes, 50 per group) were retrospectively analyzed. Patients received either intracameral Mydrane alone or topical cyclopentolate with intracameral lidocaine. Pupil diameter at the start and end of surgery, surgical duration, visual acuity, intraoperative complications, and postoperative adverse events were compared. RESULTS There was no statistically significant difference in surgical duration between the intracameral Mydrane group (8.80 min) and the topical cyclopentolate plus intracameral lidocaine group (9.24 min; P=0.54), nor in postoperative visual acuity at any distance. However, the initial pupil diameter was significantly larger in the topical cyclopentolate group (7.39±0.47 mm) than in the intracameral Mydrane group (6.08±1.05 mm; P<0.005), indicating a very large clinical effect size (Cohen's d=1.61). Pupil size at the end of the procedure showed no significant difference between the groups. No major intraoperative complications, such as posterior capsule rupture, were observed in either group. CONCLUSIONS In this cohort, topical cyclopentolate served as a safe and effective alternative to intracameral mydriasis, offering significantly wider initial pupil dilation while maintaining comparable surgical efficiency in uncomplicated cataract cases. Given its cost-effectiveness and wide accessibility, it remains a valuable strategy for resource-limited settings and complex cases requiring maximal visualization. Its potential utility in complex cases requiring maximal visualization remains a hypothesis to be evaluated in future prospective studies.