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Abstract
Purpose
To evaluate the effect of intracameral phenylephrine/ketorolac (1%/0.3%) during cataract surgery on the use of iris fixation ring and surgical time in patients with poor pupil dilation (≤5.0 mm) or intraoperative floppy iris syndrome (IFIS).
Setting
Private practice outpatient surgical center.
Design
This retrospective analysis was conducted from January 1, 2014 to October 7, 2015.
Materials and methods
The use of iris fixation rings was evaluated in a retrospective analysis of 46 patients who underwent cataract surgery from January 1, 2014, to October 7, 2015, and who were identified before surgery to be at risk for intraoperative miosis. The qualifying factors were presurgical examination of pupil dilation ≤5.0 mm after being administered topical tropicamide 1% and phenylephrine 2.5% or history of IFIS during surgery in the fellow eye. All patients received a 2-day preoperative course of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and day-of-surgery preoperative dilation using topical cyclopentolate 1%, tropicamide 1%, and phenylephrine 10%. Phenylephrine/ketorolac 1%/0.3% (Omidria®) or epinephrine 1:1,000 with sulfites was added to the ophthalmic irrigation solution and delivered intracamerally at the start of the procedure and throughout surgery. The use of iris fixation rings and surgical time for each patient were captured for each group.
Results
Eighteen (50%) of the patients in the epinephrine group and no patients in the phenylephrine/ketorolac group required iris fixation ring insertion to maintain pupil dilation or to control IFIS (p=0.0034). Mean surgical time was significantly shorter in the group of patients who received phenylephrine/ketorolac (p=0.0068).
Conclusion
In this retrospective cohort analysis of patients with poorly dilated pupils and/or IFIS, the use of intracameral phenylephrine/ketorolac in patients at risk for intraoperative miosis resulted in significantly less iris fixation ring use and significantly shorter surgical time when compared with intracameral epinephrine use.
Acknowledgments
Omeros Corporation provided medical writing support for this paper. This study was previously presented at the American Society of Cataract and Refractive Surgery 2016, New Orleans, LA, USA, Sunday, May 8, 2016, Paper Session 2-Q, #22817.
Disclosure
Dr Visco is a consultant for Omeros Corporation. She has received honoraria or payments for consulting or speaking services for Bausch + Lomb, Inc., i-Optics, LENSAR, Inc., Omeros Corporation, RVO, Sun Ophthalmic, and Shire Plc. The author reports no other conflicts of interest in this work.