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J Cataract Refract Surg. 2019 Apr;45(4):465-469. doi: 10.1016/j.jcrs.2018.11.004. Epub 2019 Jan 17.

Continuous intracameral phenylephrine-ketorolac irrigation for miosis prevention in femtosecond laser-assisted cataract surgery: Reduction in surgical time and iris manipulation.

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Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA. Electronic address:
Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA.



To determine whether the addition of phenylephrine 1.0%-ketorolac 0.3% (Omidria) to the irrigation solution during femtosecond laser-assisted cataract surgery (FLACS) reduces surgical time and the need for pupil expansion devices compared with the irrigation solution containing epinephrine.


Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA.


Retrospective case series.


Data were collected from consecutive patients. One group had epinephrine 1 μg/mL in the irrigating solution and the other group, had phenylephrine and ketorolac 4 mL added to 500 mL irrigation solution instead of epinephrine. All patients received preoperative topical bromfenac 2 days before surgery. The same surgeon performed all procedures using the same laser (Catalys) and operative conditions. Endpoints were surgical time and the use of pupil expansion devices.


Data were collected from 200 consecutive patients, 100 in each group. Patient demographics, including a mean baseline pupil size of 7.1 mm, were similar between the groups. Mean surgical times were significantly reduced in the phenylephrine-ketorolac group versus the epinephrine group (8.1 minutes versus 9.4 minutes) (P = .007). When eyes requiring a pupil expansion device were eliminated, there was still a significant reduction in surgical time for phenylephrine-ketorolac versus epinephrine (8.1 minutes versus 9.0 minutes) (P = .018). Two eyes (2%) in the phenylephrine-ketorolac group and 12 eyes (12%) in the epinephrine group required a pupil expansion device (P = .009).


These data support the hypotheses that using phenylephrine and ketorolac reduces FLACS time and the need for pupil expansion devices.


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