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    Intracameral phenylephrine/ketorolac superior to intracameral epinephrine

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



    Twenty adverse events occurred for a rate of 3.1% that included a dislocated lens with IOL exchange or repositioning, retained and dropped lens fragments, wound leakage, capsular tear alone, capsular tear and anterior vitrectomy, macular puckering postoperatively, and retinal detachment postoperatively.

    “A higher incidence of complications was seen when pupillary dilating devices were used (11.1% with rings and hooks versus 2.5% with no devices, p = 0.001), and a lower incidence of complications occurred in the drug combination group compared with the epinephrine group (1.1% versus 4.5%, respectively, p = 0.018),” he said.

    When the complications data were analyzed for all patients, Dr. Donnenfeld reported, “Complications occurred most frequently when both mydriatic-assist devices were used in conjunction without the drug combination; conversely, complications occurred least frequently when the drug combination was administered concurrently without a mydriatic-assist device.”

    In the 53 patients who had a history of use of alpha-1 adrenergic antagonists, the use of the drug combination was associated with a lower dependence on mydriatic assist devices.

    Visual acuity

    There was a significant improvement in the mean BCVA day 1 postoperatively in the age-matched patients who received the drug combination compared with those who received epinephrine. For patients aged 69 to 76 years, the respective BCVA was 0.44 ± 0.08 versus 0.38 ± 0.10, and for those aged 76 to 92 years, the respective BCVA was 0.34 ± 0.06 versus 0.23 ± 0.08 (p < 0.001).

    In the age-matched patients, a significant improvement was seen in UCVA on day 1 postoperatively in patients who received the drug combination.

    The differences between the two study groups increased with increasing patient age, such that in those 62 to 68 years, the respective visual acuities in the drug combination group and epinephrine group were 0.428 and 0.395, in those 69 to 75 years, 0.443 and 0.383, and in those 76 to 92 years 0.339 and 0.227 (p = 0.003).

    Dr. Donnenfeld summarized, “When compared to intracameral epinephrine, intracameral phenylephrine/ketorolac administration was associated with statistically significant decreases in intraoperative and postoperative complications, decreased use of pupillary dilating devices, improved UCVA on day 1 postoperatively, and decreased surgical time.”



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