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  • Intracameral phenylephrine-ketorolac may mitigate inflammation after cataract surgery

    Cataract/Anterior Segment, Cornea/External Disease

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    Review of: Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery

    Visco D, Bedi R. Journal of Cataract & Refractive Surgery, June 2020

    This retrospective study assessed the effectiveness of intracameral phenylephrine-ketorolac during cataract surgery versus postoperative topical steroids.

    Study design

    The study included 1,334 eyes receiving intracameral phenylephrine 1.0%-ketorolac 0.3% during cataract surgery and 884 eyes receiving topical loteprednol 0.5% 2 days preoperatively and tapered postoperatively. Researchers excluded patients with prior CME or who were at high risk for postoperative CME, had combined cataract/glaucoma surgery, or had medication protocols different from those used in this study. All eyes received bromfenac 2 days before and 10 weeks after surgery. The incidences of postoperative cystoid macular edema (CME), breakthrough iritis, pain and photophobia were evaluated.

    Outcomes

    The phenylephrine-ketorolac group had a significantly lower incidence of CME (0.5% vs. 1.5%; P=0.021), breakthrough iritis (1.7% vs. 4.9%; P<0.001) and pain (1.3% vs. 4.2%; P<0.001) than controls. The incidence of photophobia in the study arm was not statistically significant (0.9% vs. 1.1%; P=0.6).

    Limitations

    This study was both unmasked and retrospective. The results cannot be extrapolated to all cataract patients since individuals with a high risk for postoperative CME were excluded. In addition, postoperative NSAIDs were maintained for 10 weeks which is longer than most cataract postoperative drug regimens.

    Clinical significance

    These findings suggest it may be beneficial to add intracameral phenylephrine 1.0%-ketorolac 0.3% to the pharmaceutical regimen during cataract surgery because it reduces both the burden of perioperative corticosteroid drops and dependence on patient compliance for control of inflammation. When combined with perioperative topical NSAIDs for 10 weeks, it may be a better prophylactic regimen for postoperative CME, iritis, and pain than regimens involving compliance-dependent topical steroids with topical NSAIDs for low risk cataract patients.