Critical appraisal of ophthalmic ketorolac in treatment of pain and inflammation following cataract surgery

Figures & data

Table 1 Clinical studies with ketorolac in post-cataract surgery inflammation and pain

Author	Year	Patients/Eyes	Ketorolac	Dosing regimen	P = cells/flare	P = pain	Conclusions
El Harazi et al^Citation5	1988	58 pts	0.50%	4 × daily 1 wk then BID × 3 wks			Ketorolac = diclofenac = prednisolone 1% for inflammation
Flach et al^Citation6	1988	118 pts	0.50%	1 gtt 3 × daily	0.001		Ketorolac > placebo for inflammation
Flach et al^Citation7	1989	127 pts	0.50%	Pre and postoperatively	0.53		Ketorolac = dexamethasone for inflammation
Ostrov et al^Citation8	1997	157 pts	0.50%	1 day preop and 4 wks postop			Ketorolac = prednisone 1% = dexamethasone for inflammation
Heier et al^Citation9	1999	102 pts	0.50%	4 × daily	0.030/0.025	0.049	Ketorolac > placebo for inflammation and pain
Simone et al^Citation10	1999	59 pts	0.50%	1 to 2 drops 4 times daily × 1 wk then tapered			Ketorolac = prednisolone 1% for inflammation and pain
Snyder et al^Citation11	2000	26 pts	0.50%	Pre and postoperatively			Ketorolac = flurbiprofen/prednisolone 1% for inflammation
Soloman et al^Citation12	2001	104 eyes	0.50%	4 × daily starting 24 hrs after surgery	0.0002/0.001	0.043	Ketorolac > placebo for inflammation
Soloman et al^Citation13	2001	36 pts	0.50%	4 × daily starting 24 hrs after surgery	0.17/0.48		Ketorolac = rimexolone 1% for cell/flare
Holzer et al^Citation14	2002	60 pts	0.50%	4 times a day × 1 wk then BID × 3 wks			Ketorolac = loteprednol for inflammation
Trinivarat et al^Citation15	2003	120 pts	0.50%	4 × daily	0.008		Prednisolone > ketorolac for inflammation
Price and Price^Citation16	2004	25 pts (50 eyes)	0.40%	4 × daily starting 3 days prior and 1 day after CE		0.02	Ketorolac > placebo for pain
Donnenfeld et al^Citation17	2006	4 grps of 25	0.40%	4 times daily pre and post operatively	0.001	0.001	Preoperative ketorolac decreased inflammation
Sandoval et al^Citation18	2006	40 eyes total	0.4%/0.5%	4 × daily × 1 wk then BID × 3 wks			Comparative study revealed 0.5% > stinging/burning
Duong et al^Citation19	2007	193 eyes	0.40%	4 × daily	0.33	0.025	Ketorolac > nepafenac for pain
Maca et al^Citation20	2010	100 pts	0.50%	4 × daily		0.001	Diclofenac = ketorolac for inflammation
Donnenfeld et al^Citation21	2011	511 pts	0.45%	2 × daily	0.001	0.001	Ketorolac > placebo for pain and inflammation

Table 2 Reported ranges of IC₅₀ for COX-1 and COX-2 of ocular NSAIDs

Drug	COX-1 IC50μm (ng/mL)	COX-2 IC50μm (ng/mL)
Amfenac	0.14 to 0.25 (35.6 to 63.6)	0.002 to 0.15 (0.51 to 38.1)
Diclofenac	0.12 to 0.95 (38 to 302.1)	0.03 to 0.09 (9.5 to 28.6)
Ketorolac	0.014 to 0.02 (5.3 to 7.5)	0.09 to 0.12 (33.9 to 45.2)
Bromfenac	0.09 to 0.53 (3.4 to 203.1)	0.007 to 0.023 (2.7 to 8.8)

Abbreviations: COX, cyclooxygenase; IC₅₀, half-maximum inhibition relative to control values.

Figure 1 Corticosteroids inhibit phospholipase A₂ while nonsteroidal anti-inflammatory drugs act more downstream and directly inhibit cyclo-oxygenase.

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