Combination cyclopentolate and phenylephrine for mydriasis in premature infants with heavily pigmented irides

Purpose: This study examined whether safe and effective mydriasis can be ac hieved in premature infants with heavily pigmented irides using combination cyclopentolate 0.2% and phenylephrine 1% eyedrops. Methods: A prospective, randomized double-blind study was performed to comp are combination cyclopentolate 0.2% and phenylephrine 1% eyedrops with trip le instillation of tropicamide 0.5% and phenylephrine 2.5%. Twenty-eight co nsecutive babies with dark irides and birthweight <1600 g referred for scre ening for retinopathy of prematurity comprised the study population. Infant s' eyes were randomly dilated twice with both regimens within a 2-week peri od. Blood pressure, heart rate, and pupil size were measured. Results: Good mydriasis was achieved in both groups with no significant dif ferences in pupil size or blood pressure (systolic, diastolic, or mean arte rial pressures) over starting baseline values. Pulse rates decelerated belo w the baseline values in both groups, but these differences were not large. Conclusion: The single combination eyedrop of cyclopentolate 0.2% and pheny lephrine 1% is as effective and safe a mydriatic for infants with dark irid es as both tropicamide 0.5% and phenylephrine 2.5%.