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    Intracameral phenylephrine/ketorolac superior to intracameral epinephrine

    Retrospective chart analysis: Initial experience, visual outcomes, efficacy during cataract surgery


    Real-world analysis

    Dr. Donnenfeld and colleagues conducted a retrospective chart analysis to test the efficacy of the intracameral drug combination for its effects on perioperative complications, surgical duration, changes in BCVA and uncorrected visual acuity (UCVA) levels, and the use of devices to dilate pupils in a patient population.

    This study was more encompassing than that in the FDA trials and included patients with IFIS, pseudoexfoliation, and otherwise poorly dilating pupils.

    Four surgeons performed all procedures at one study site from August to November 2015, he explained.

    The drug combination was added to the balanced saline irrigating solution in the study group, and epinephrine was added to the irrigating solution in the control group.

    Investigators compared the results from both groups. Patients in both groups received standard topical NSAIDs administered preoperatively. All charts were reviewed at least 1 month postoperatively. Patients were excluded who had a sensitivity to NSAIDs and had undergone combined cataract and posterior segment surgeries.

    Dr. Donnenfeld reported that 641 cataract extractions were performed in 389 patients (413 women, 228 men). Two hundred sixty patients received the intracameral phenylephrine 1.0% and ketorolac 0.3% drug combination and 381 received intracameral epinephrine. Forty-five patients required use of a Malyugin ring or iris hooks.

    Surgical duration

    The surgical duration was significantly (p = 0.049) shorter in the group treated with the drug combination when all patients were included in the analysis. The greatest difference was seen in patients who ranged in age from 65 to 70 years, i.e., in the drug combination group, the surgery lasted 13.5 minutes compared with 17.2 minutes in the epinephrine group.

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