October 2018

RESIDENTS

EyeWorld journal club
Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy iris syndrome


by Steven Silverstein, MD, Viren Rana, MS, Robert Stephens, PhD, Larry Segars, PharmD, Joseph Pankratz, MS, Shivani Rana, Mark Juzych, MD, Nissiri Nariman, MD

J Cataract Refract Surg. 2018;44(9):1103–1108.

Purpose: To determine the effect of Omidria (phenylephrine and ketorolac injection 1%/0.3%) on different components of intraoperative floppy iris syndrome (IFIS).
Setting: Silverstein Eye Centers, Kansas City, Missouri
Design: A single surgeon, single center, double-masked prospective comparative study double
Methods: 50 eyes of 50 male patients treated with tamsulosin underwent standard cataract extraction surgery. Twenty-five patients (the treatment group) received phenylephrine and ketorolac injection 1%/0.3% in the irrigation solution, while 25 patients (the control group) received basic saline solution. Every procedure was video recorded using endoscopic cyclophotocoagulation (ECP) probe and microscopic view. Pupil dilation, iris billowing, and iris prolapse were measured using a micrometer, ECP recording grading scale, and microscopic recordings, respectively.
Results: While both groups showed a decrease in pupillary diameter before and after cataract extraction, and before cataract extraction and after intraocular lens implant, the changes were statistically significantly greater in the treatment group. Iris prolapse occurred in 3 out of 25 (12.0%) in the treatment group versus 14 out of 25 (56.0%) in the control (p<0.001). Stage 3 (severe) billowing was seen in 1 (4.0%) of the treatment group and 10 (40.0%) of the control (p<0.001).
Conclusions: The use of the phenylephrine and ketorolac injection 1%/0.3% combination added to the irrigating solution during cataract surgery in patients at risk for IFIS leads to significantly better prevention of miosis, less pupillary billowing, and a reduced incidence of iris prolapse. A new grading scale for intraoperative iris abnormalities may be used for future evaluation.

Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy iris syndrome Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy iris
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2018-10-08T14:35:05Z
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