Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Ey...

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Autores principales:	Grob SR, Gonzalez-Gonzalez LA, Daly MK
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/262e50afb91044e3b9bb95831d3e6fc2
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spelling	oai:doaj.org-article:262e50afb91044e3b9bb95831d3e6fc22021-12-02T06:38:11ZManagement of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions1177-5483https://doaj.org/article/262e50afb91044e3b9bb95831d3e6fc22014-07-01T00:00:00Zhttp://www.dovepress.com/management-of-mydriasis-and-pain-in-cataract-and-intraocular-lens-surg-a17458https://doaj.org/toc/1177-5483 Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 4Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA Abstract: The maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this combination have demonstrated statistically significant differences when compared to placebo in maintaining intraoperative mydriasis (P<0.00001) and in reducing pain in the early postoperative period (P=0.0002). This medication may be of benefit for use in cataract and lens replacement surgery in the near future. Keywords: ketorolac, phenylephrine, intraocular lens replacement surgery, mydriasisGrob SRGonzalez-Gonzalez LADaly MKDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 1281-1289 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Grob SR Gonzalez-Gonzalez LA Daly MK Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
description	Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 4Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA Abstract: The maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this combination have demonstrated statistically significant differences when compared to placebo in maintaining intraoperative mydriasis (P<0.00001) and in reducing pain in the early postoperative period (P=0.0002). This medication may be of benefit for use in cataract and lens replacement surgery in the near future. Keywords: ketorolac, phenylephrine, intraocular lens replacement surgery, mydriasis
format	article
author	Grob SR Gonzalez-Gonzalez LA Daly MK
author_facet	Grob SR Gonzalez-Gonzalez LA Daly MK
author_sort	Grob SR
title	Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
title_short	Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
title_full	Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
title_fullStr	Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
title_full_unstemmed	Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
title_sort	management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/262e50afb91044e3b9bb95831d3e6fc2
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Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

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