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Intracameral ketorolac concentration at the beginning and end of cataract surgery following preoperative topical ketorolac administration

Authors Katsev DA, Katsev CC, Pinnow J, Lockhart CM

Received 19 August 2017

Accepted for publication 5 October 2017

Published 24 October 2017 Volume 2017:11 Pages 1897—1901


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Douglas A Katsev,1 Cailyn C Katsev,1 Jen Pinnow,2 Catherine M Lockhart3

1Santa Barbara Surgery Center, Santa Barbara, CA, 2Pinnow Consulting, Bellingham, WA, 3Omeros Corporation, seattle, WA, USA

Purpose: To evaluate the intracameral concentration of ketorolac tromethamine (ketorolac) at the beginning and end of cataract surgery following preoperative topical administration.
Setting: Santa Barbara Surgery Center, Santa Barbara, CA, USA.
Design: This was a pre–post, interventional, single-arm study.
Patients and methods: Patients undergoing cataract extraction and lens replacement (CELR) were eligible. Written informed consent was obtained from 14 patients who were prescribed topical ophthalmic ketorolac according to the surgeon’s usual practice beginning the day prior to surgery. The surgeon withdrew 100 µL of aqueous humor from the operative eye immediately prior to the initial surgical incision and again just prior to final anterior chamber reinflation and wound closure. Ketorolac concentrations in the intracameral fluid samples were measured.
Results: Thirteen of 14 patients used four doses of ketorolac the day prior to surgery as directed, and one patient used three doses. On the day of surgery, all 14 patients administered one drop of topical ketorolac on awakening and one drop after arriving at the surgery center. Preoperative ketorolac concentrations for the 12 patients from whom samples were collected ranged from 4.9 to 369 ng/mL. End-of-procedure sample concentrations ranged from <1.0 (the lower limit of quantification [LLOQ]) to 6.32 ng/mL, with eight of 12 patients having ketorolac levels below the LLOQ.
Conclusion: At-home compliance with topical ketorolac was good, with 92.9% of patients using it as directed. Following CELR, levels of ketorolac in the aqueous humor were low, and 66.7% of patients had undetectable levels.

Keywords: cataract surgery, NSAIDs, ketorolac, topical administration, intracameral drug concentration

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