Take-home message: The addition of phenylephrine 1%/ketorolac 0.3% injection to the irrigation bottle maintains pupil dilation and makes patients more comfortable intra- and postoperatively.
Nashville, TN—As an adjunct to cataract surgery, phenylephrine 1%/ketorolac 0.3% injection (Omidria, Omeros) is an easy-to-use product that makes the procedure easier for patients and surgeons and improves the postoperative recovery, according to James C. Loden, MD.
Dr. Loden was an investigator in one of the phase III studies investigating phenylephrine/ketorolac injection. Based on that first-hand experience, he immediately adopted the product into clinical practice once it became commercially available.
Phenylephrine/ketorolac injection is added to the irrigation solution. It has pass-through reimbursement status, and Dr. Loden is using it routinely in all patients covered under Medicare part B.
“The combination of phenylephrine and ketorolac is very effective in preventing miosis, and that allows the surgery to be completed faster and with greater safety,” said Dr. Loden, president, Loden Vision Centers, Nashville, TN.
“The presence of ketorolac in the anterior chamber throughout the procedure also seems to improve patient comfort, and I believe it results in much better tissue penetration than a topical NSAID so that it dramatically limits prostaglandin release, resulting in enhanced control of postoperative pain and inflammation,” Dr. Loden said.
Anecdotally, the benefits of intracameral phenylephrine/ketorolac also seem to be translating into reduced corneal edema on the first postoperative day along with more rapid visual recovery, he noted.
“We are now collecting data to further investigate those observations,” he said.
Primary efficacy analyses
In the phase III clinical trials, patients were treated with topical mydriatic and anesthetic agents and randomly assigned to receive the phenylephrine/ketorolac injection added to the irrigating solution or placebo. The primary efficacy analyses showed that patients who received the active agent had significantly greater maintenance of pupil diameter and significantly less postoperative pain.