© 2014 Wichtg Publishing EJO ISSN 1120-6721 Eur J Ophthalmol 2015; 25 (3): 249-253 ORIGINAL ARTICLE The best mydriatc regimen for ROP screening is un- clear. Previous studies have investgated the use of diferent strengths and combinatons of mydriatcs in ROP screening but were limited by small sample sizes. Two such small stud- ies of 39 and 15 infants reported a combinaton of cyclopen- tolate 0.2% + phenylephrine 1% to be efcacious in mydriatc efect (6, 7). A combinaton of tropicamide 0.75% with phen- ylephrine 2.5% did not demonstrate any signifcant diference in mydriatc efect, if given 5 minutes or 30 minutes apart (8). A small nonblinded study of 26 patents showed that a reduc- ton in mydriatc drop size (from 26 µL to 5 µL) did not have a signifcant depreciatve efect on the degree of mydriasis (9). A study of 50 preterm infants undergoing their frst ROP examinaton suggested that apneic episodes were the only adverse efects sustained over the subsequent 48 hours, al- though it was not possible to establish whether these were directly related to mydriatc usage (cyclopentolate 0.2% and phenylephrine 2.5%) (10). The use of cyclopentolate 1% has been associated with heart rate and blood pressure rises postnstllaton (6). However, another small study showed no clinically signifcant efect on vital observatons with the use of cyclopentolate 0.5% and phenylephrine 2.5% given 4 tmes, 15 minutes apart (11). A case report and a case series have postulated a possible associaton between ROP screen- ing and necrotzing enterocolits (NEC), though any causatve DOI: 10.5301/ejo.5000540 Efcacy and safety of phenylephrine 2.5% with cyclopentolate 0.5% for retnopathy of prematurity screening in 1246 eye examinatons James E. Nefendorf, P. Michael Mota, Kanmin Xue, G. Darius Hildebrand Royal Berkshire Hospital, Reading and King Edward VII Hospital, Windsor - UK Introducton Retnopathy of prematurity (ROP) is the major cause of permanent and ofen bilateral visual loss in infancy (1). It is largely preventable, if appropriate screening and tmely treat- ment are performed. A United Kingdom–based populaton study demonstrated a decrease in childhood visual disability, as defned by World Health Organizaton criteria, from 5%-8% in 1990 to 3% in 2000 as a result of ROP screening and raised awareness of the conditon (2). It is estmated that 66%-68% of babies born under 1251 g will develop some degree of ROP, although the vast majority will not develop sight-threatening sequelae (3-5). Screening for ROP is therefore recommended for all infants at risk. ABSTRACT Purpose: Retnopathy of prematurity (ROP) is a leading cause of visual loss in infancy that is largely preventable with careful screening. We report the safety and efcacy of the use of phenylephrine 2.5% and cyclopentolate 0.5% eyedrops instlled 3 tmes 5 minutes apart in ROP screening. Methods: A total of 1246 ROP screening eye examinatons were carried out by the same pediatric ophthalmolo- gist between February 2011 and May 2013. Outcome measures were successful mydriasis (defned as achieving a full screening examinaton) and any intraprocedural systemic complicatons (defned as any respiratory, cardiac, or other clinical deterioraton severe enough to result in screening abandonment). Results: Of 1246 eyes, 1234 (98.8%) achieved successful dilaton to enable complete screening. A fourth applica- ton was successful in the remaining 1.2%. No respiratory or cardiac arrest or any other intraprocedural event requiring cessaton of screening was encountered during any of the examinatons. No retnal bleeding or other intraocular complicaton occurred. Conclusions: This is the largest cohort studying the efectveness and safety of a mydriatc regimen for ROP screening. We have found the combinaton of phenylephrine 2.5% with cyclopentolate 0.5% to be efcacious and well-tolerated. The absence of any severe intraprocedural complicatons may be related to reduced indentaton tme and stress in the infant facilitated by efectve pupil dilaton. Keywords: Cyclopentolate, Phenylephrine, Retnopathy of prematurity, Safety Accepted: October 26, 2014 Published online: November 14, 2014 Corresponding author: James E. Nefendorf King Edward VII Hospital St Leonard Road Windsor SL4 3DP United Kingdom james.nefendorf@gmail.com