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    Combination therapy targets pupil maintenance, pain

     

    Better pupil maintenance

    Demographics and cataract characteristics were similar between the group receiving phenylephrine/ketorolac and the placebo group. The group receiving phenylephrine/ketorolac had better pupil maintenance at all time points, and there was less postoperative pain, said Dr. Walters, who is in private practice at Austin, TX.

    Figure 2. Researchers used the mean area under the curve analysis to measure postoperative subject-reported ocular pain as measured by a Visual Analog Scale.

    As for postoperative ocular pain, “it increased in the placebo group with increasing surgical duration, but was numerically similar in the phenylephrine/ketorolac group,” Dr. Walters added.

    Adverse events were reported in 60% and 66.9% of the phenylephrine/ketorolac and placebo groups, respectively. The most common adverse events in the treatment group were eye pain and eye inflammation. Eye pain was more common in the placebo group.

    The addition of phenylephrine/ketorolac to the cataract surgeon’s armamentarium is important because of the risks associated with pupil constriction, Dr. Walters said.

    “You can get iris touch with the phaco probe, which induces miosis and inflammation,” Dr. Walters explained. “When you have reduced visibility of the lens, it makes the procedure more difficult for the surgeon and potentially more complicated for the patient with iris trauma and post-op inflammation.”

    Concerns about pupil constriction are especially prevalent in older patients and those with floppy iris syndrome or diabetes.

    “All are prone to post-op inflammation,” Dr. Walters said. “It makes the procedure more difficult if the pupil constricts. This medication aids with ease of the procedure and quicker visual recovery.”

     

    Thomas Walters, MD.

    e: [email protected]

    This article was developed based on Dr. Walters’ presentation at the 2016 American Society of Cataract and Refractive Surgery annual meeting. Dr. Walters is a consultant for the Omeros Corp.

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