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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.

Author information

1
Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA. Electronic address: kwalter@wakehealth.edu.
2
Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA.

Abstract

PURPOSE:

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.

SETTING:

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

DESIGN:

Retrospective case series.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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

PMID:
30661968
DOI:
10.1016/j.jcrs.2018.11.004

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