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Kremer LJ, Reith DM, Medlicott N, et al. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Paediatr Open. 2019;3(1):e000448doi: 10.1136/bmjpo-2019-000448.
Kremer, L. J., Reith, D. M., Medlicott, N., & Broadbent, R. (2019). Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ paediatrics open, 3(1), e000448. https://doi.org/10.1136/bmjpo-2019-000448
Kremer, Lisa Jean, et al. "Systematic review of mydriatics used for screening of retinopathy in premature infants." BMJ paediatrics open vol. 3,1 (2019): e000448. doi: https://doi.org/10.1136/bmjpo-2019-000448
Kremer LJ, Reith DM, Medlicott N, Broadbent R. Systematic review of mydriatics used for screening of retinopathy in premature infants. BMJ Paediatr Open. 2019 May 09;3(1):e000448. doi: 10.1136/bmjpo-2019-000448. eCollection 2019. PMID: 31206081; PMCID: PMC6542421.
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BMJ Paediatr Open. 2019 May 09;3(1):e000448. doi: 10.1136/bmjpo-2019-000448. eCollection 2019.

Systematic review of mydriatics used for screening of retinopathy in premature infants.

BMJ paediatrics open

Lisa Jean Kremer, David M Reith, Natalie Medlicott, Roland Broadbent

Affiliations

  1. School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand.
  2. Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.

PMID: 31206081 PMCID: PMC6542421 DOI: 10.1136/bmjpo-2019-000448

Abstract

INTRODUCTION: Routine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines.

OBJECTIVE: This review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination.

METHOD: Systematic literature review.

RESULTS: There is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports.

CONCLUSIONS: Current international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.

Keywords: cyclopentolate; mydriatic; neonate; phenylephrine; retinopathy of prematurity; tropicamide

Conflict of interest statement

Competing interests: None declared.

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