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    Intracameral phenylephrine/ketorolac superior to intracameral epinephrine

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

    Take-Home Message: Phenylephrine 1%/ketorolac injection 0.3% added to ophthalmic irrigation solution and administered intracamerally during cataract surgery was associated with a statistically significant reduction in surgical time, intraoperative complications, and use of pupil dilating devices and with a statistically significant improvement in best-corrected visual acuity.



    Efforts to improve the performance and outcomes of cataract surgery continue, and surgeons have taken another step forward in that regard.

    The addition of intracameral phenylephrine/ketorolac to the surgical regimen is known to maintain pupillary dilation.

    In addition, investigators also found the drug combination of phenylephrine 1.0% and ketorolac 0.3% (Omidria, Omeros Corp.) was superior to intracameral epinephrine by decreasing the rates of intraocular complications, the necessity for using pupillary dilation devices during cataract surgery, the length of the surgery, and best-corrected visual acuity (BCVA) outcomes.

    The agent is the first combination drug administered intracamerally to receive FDA approval for routine use during cataract surgery.

    Because cataract surgery is one of the most frequently performed procedures worldwide and the technology associated with the surgery is so far advanced, patients have increasingly high expectations for a safe, rapid, and comfortable return of functional vision, noted Eric D. Donnenfeld, MD.

    However, despite the frequency with which cataract surgeries are performed, complications related to the surgery can still occur, with small pupils being a well-known risk factor for complications, said Dr. Donnenfeld, clinical professor of ophthalmology, New York University School of Medicine, New York, and founding partner, Ophthalmic Consultants of Long Island and Connecticut.

    Visualization is all-important during creation of the capsulorhexis, phacoemulsification, cortical clean-up, and IOL implantation. In patients with small pupils, the surgical scenes can differ dramatically between well-dilated pupils and miotic pupils.

    When the intracameral combination of phenylephrine and ketorolac was being evaluated, the FDA trials showed significant improvements in the drug’s ability to maintain pupillary mydriasis and reductions in postoperative pain. All trial patients received preoperative topical mydriatics and analgesics, no preoperative nonsteroidal anti-inflammatory drugs (NSAIDs) or intracameral epinephrine were administered in the experimental and control groups. Patients with risk factors for pupillary constriction, such as intraoperative floppy iris syndrome (IFIS) and pseudoexfoliation, were excluded from the FDA trials.

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