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Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis

Authors Visco D

Received 19 August 2017

Accepted for publication 7 December 2017

Published 5 February 2018 Volume 2018:12 Pages 301—305

DOI https://doi.org/10.2147/OPTH.S149522

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Jie Zhang

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Denise Visco

Eyes of York Cataract & Laser Center, York, PA, USA

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.

Keywords:
cataract extraction, miosis, phenylephrine, ketorolac, iris fixation ring, Malyugin ring, OMS302, Omidria®

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