Archives of Anesthesiology and Critical Care 2016. 2(2):184-188.

The Effect of Prophylactic Administration of Ketorolac Ophthalmic Suspension on Prevention of Surgically Induced Miosis in Patients Undergoing Cataract Surgery
Mehdi Sanatkar, Mehrdad Goudarzi, Hamed Ghassemi, Mahsa Keyhanian, Amir Abbas Yaghooti, Hossein Sadrossadat, Reza Ghafari, Shahrokh Ghazizadeh, Hassan Mohammadi Poor Anvari, Somaye Asadi

Abstract


Background: Cataract extraction surgery remains the most commonly performed eye surgery by ophthalmologists. The maintenance of mydriasis is required throughout surgery to allow better visualization of the surgical field and a greater working space within the center of the eye. Non-steroidal anti-inflammatory agents (NSAIDs) have their effect in maintaining mydriasis by their ability to inhibit prostaglandin synthesis.

Methods: This was a prospective, randomized clinical trial study in 84 patients undergoing phacoemulsification cataract surgery. Patients were randomized to ketorolac tromethamine 0.5% (n=42) or the control group (n=42). Patients in the ketorolac group received one drop of ketorolac every 15 min for a total of 4 drops from one hour before surgery. The horizontal diameters of the pupil were measured in millimeters with a caliper under the microscope at the following stages: before surgery, after intracameral epinephrine injection, after nuclear emulsification and at the end of surgery.

Results: The difference in pupillary diameter at the end of surgery was statistically significant between two groups (7.34 ± 1.0 mm and 8.01 ±0.67 mm in the control and the ketorolac groups, respectively; p=0.018). The difference in mean pupil size after intracameral epinephrine injection and after nuclear emulsification between the control group (0.51 ± 0.25 mm) and the ketorolac group (0.01 ± 0.20 mm) was statistically significant (p <0.001). Moreover, the difference in mean pupil size after intracameral epinephrine injection and at the end of surgery between the control group (0.79 ± 0.44 mm) and the ketorolac group (0.19 ± 0.23 mm) was statistically significant (p <0.001). There was no difference in maintaining mydriasis between diabetic patients and non-diabetic patients.

Conclusion: Topical ketorolac is an effective inhibitor of miosis during phacoemulsification cataract surgery, and provides a more stable mydriatic effect throughout the surgical procedure.


Keywords


cataract surgery; ketorolac tromethamine; mydriasis; miosis; pupil diameter

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