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To evaluate the effectiveness of intracameral phenylephrine and ketorolac 1.0%/0.3% during cataract surgery compared to postoperative steroids in reducing the risk of postoperative cystoid macular edema (CME), breakthrough iritis, photophobia, and pain.
Single-site, 2-cohort, retrospective study of cataract surgery patients to assess postoperative CME, breakthrough iritis, photophobia, and pain. Patients received either intracameral phenylephrine and ketorolac 1.0%/0.3% (n=1334) during surgery or topical loteprednol 0.5% (n=884) given 2 days preoperatively and tapered postoperatively. Patients with prior CME, combined cataract/glaucoma surgery, and medication protocols different from those examined in this study were excluded, as were eyes at high risk for postoperative CME from retinal vein occlusion, vitreomacular traction, macular pucker, and epiretinal membrane. All patients received bromfenac 2 days pre- and 10 weeks postoperatively.
The study enrolled 2218 eyes of 1402 patients (831 females, 571 males). The phenylephrine/ketorolac study group included 1334 eyes of 830 patients (mean 69.2 ± 9.4 years) and loteprednol control group included 884 eyes of 572 patients (mean 67.6 ± 9.1 years). The groups were comparable in terms of race, gender, and most perioperative characteristics. CME incidence was significantly lower in the study group (0.5% vs 1.47%, P=0.021). The study group also had significantly lower incidence of breakthrough iritis (1.7% vs 4.9%, P<0.001) and pain (1.3% vs 4.19%, P<0.001) compared with the control group. The incidence of photophobia was comparable (0.9% vs 1.13%, P=0.590) between the two groups.
Intracameral phenylephrine/ketorolac and topical NSAIDS (without postoperative steroids) significantly reduced postoperative CME, breakthrough iritis, and pain after cataract surgery compared with conventional perioperative treatment using topical steroids and NSAIDS. This could decrease reliance on compliance-dependent topical drop regimens.