Can an intracameral mydriatic combination reduce need for pupil expanders?
Intracameral administration of the fixed combination of phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros) during cataract surgery is safe and effective for maintaining pupil dilation, and minimizes the need for a pupil expansion device, according to the findings of a retrospective study conducted by Frank A. Bucci, Jr., MD.
Reviewed by Frank A. Bucci, Jr., MD
Wilkes-Barre, PA – Intracameral administration of the fixed combination of phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros) during cataract surgery is safe and effective for maintaining pupil dilation, and minimizes the need for a pupil expansion device, according to the findings of a retrospective study conducted by Frank A. Bucci, Jr., MD.
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“Small pupils impede intraocular visualization and increase the risk for complications during cataract surgery,” said Dr. Bucci, founder and managing director, Bucci Laser Vision Institute, Wilkes-Barre, PA. “If adequate dilation cannot be achieved with medications alone or if there is concern about intraoperative miosis, placement of a pupil expansion device offers a potential solution.”
However, using an expansion device also adds complexity, time, and cost to the surgical procedure because there is no additional facility fee for ambulatory surgery centers or hospital outpatient departments, he said. Expansion devices also add an increased risk of bleeding, pain, and inflammation.
“The fixed combination of phenylephrine and ketorolac maintains mydriasis and preemptively blocks surgical trauma-induced release of prostaglandins to prevent miosis and reduce the need for using a pupil expansion device,” said Dr. Bucci, founder and managing director, Bucci Laser Vision Institute, Wilkes-Barre, PA, adding that this also reduces facility costs and minimizes the patient risk of intraocular injury.
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Researchers have continued to collect data on pupil expansion device use during cataract surgery, and the data are consistent with the experience of the initial study, he said.
The retrospective review included data from 1185 consecutive cataract surgeries performed by Dr. Bucci at a single center in the months before and after he implemented the fixed combination phenylephrine/ketorolac product into his surgical protocol. The series was comprised of 668 control cases and 517 cases using the intracameral fixed combination.
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