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Patient considerations in cataract surgery – the role of combined therapy using phenylephrine and ketorolac

Authors Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M

Received 5 June 2016

Accepted for publication 10 August 2016

Published 15 September 2016 Volume 2016:10 Pages 1795—1801

DOI https://doi.org/10.2147/PPA.S90468

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Roberto Gonzalez-Salinas,1,2 Adriano Guarnieri,3 María Concepción Guirao Navarro,3 Manuel Saenz-de-Viteri3

1Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico; 2Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico; 3Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain

Abstract: Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients’ quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients’ expectations regarding visual recovery are also increasing.

Keywords: cataract surgery, mydriasis, phenylephrine, ketorolac, Omidria®

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