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

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 i...

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Autor principal:	Visco D
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Cataract extraction Miosis Phenylephrine Ketorolac Iris fixation ring Malyugin ring OMS302 Omidria® Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/1e80cc46a38f427fb785ae7ab26d99ee
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spelling	oai:doaj.org-article:1e80cc46a38f427fb785ae7ab26d99ee2021-12-02T01:54:45ZEffect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis1177-5483https://doaj.org/article/1e80cc46a38f427fb785ae7ab26d99ee2018-02-01T00:00:00Zhttps://www.dovepress.com/effect-of-phenylephrineketorolac-on-iris-fixation-ring-use-and-surgica-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Denise 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®Visco DDove Medical PressarticleCataract extractionMiosisPhenylephrineKetorolacIris fixation ringMalyugin ringOMS302Omidria®OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 301-305 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cataract extraction Miosis Phenylephrine Ketorolac Iris fixation ring Malyugin ring OMS302 Omidria® Ophthalmology RE1-994
spellingShingle	Cataract extraction Miosis Phenylephrine Ketorolac Iris fixation ring Malyugin ring OMS302 Omidria® Ophthalmology RE1-994 Visco D Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
description	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®
format	article
author	Visco D
author_facet	Visco D
author_sort	Visco D
title	Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
title_short	Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
title_full	Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
title_fullStr	Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
title_full_unstemmed	Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
title_sort	effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/1e80cc46a38f427fb785ae7ab26d99ee
work_keys_str_mv	AT viscod effectofphenylephrineketorolaconirisfixationringuseandsurgicaltimesinpatientsatriskofintraoperativemiosis
_version_	1718402761281765376

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

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