The Pharmacotherapy of Cataract Surgery

Arshinoff, Steve A.; Opalinski, Yvonne A.V.

doi:10.1016/b978-0-323-04332-8.00061-5

Cited by 5 publications

(6 citation statements)

References 88 publications

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“…PE is not known to have any effect on pain. KE, by inhibiting both proinflammatory cyclo-oxygenase enzymes, inhibits prostaglandin synthesis resulting from surgical trauma, thereby reducing both postoperative pain and the occurrence of intraoperative miosis 21. Intracameral irrigation of OMS302 exposes target tissues to consistent concentrations of PE and KE throughout the entire procedure.…”

Section: Introductionmentioning

confidence: 99%

“…KE, by inhibiting both proinflammatory cyclo-oxygenase enzymes, inhibits prostaglandin synthesis resulting from surgical trauma, thereby reducing both postoperative pain and the occurrence of intraoperative miosis. 21 Intracameral irrigation of OMS302 exposes target tissues to consistent concentrations of PE and KE throughout the entire procedure. In addition, unlike preoperatively administered topical drugs, which are washed out of the eye by the irrigation solution used during ILR, OMS302 continuously bathes the intraocular structures as part of the irrigation solution.…”

Section: Introductionmentioning

confidence: 99%

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Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification

Lindstrom¹,

Loden²,

Walters³

et al. 2014

OPTH

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BackgroundThe purpose of this study was to evaluate the effect of OMS302 on intraoperative pupil diameter and early postoperative ocular pain when administered during intraocular lens replacement surgery.MethodsFour hundred and six patients (406 study eyes; 202 in the OMS302 group and 204 in the placebo group) were entered into this randomized, double-masked, placebo-controlled, multicenter Phase III study, which was conducted at 15 centers in the USA and the Netherlands. The patients received OMS302 (60.75 mM phenylephrine HCl and 11.25 mM ketorolac tromethamine) or placebo in irrigation solution during intraocular lens replacement. No other changes in procedure were required. Coprimary endpoints were change in pupil diameter over time from surgical baseline to end of procedure and patient-reported ocular pain during the first 12 hours postoperatively. Secondary endpoints included additional measures of pupil diameter and postoperative pain.ResultsOMS302 was superior to placebo in maintaining intraoperative mydriasis, preventing miosis, and reducing postoperative pain. The weighted mean (standard error) difference (OMS302 – placebo) in change in the area under the curve from baseline for pupil diameter was 0.590 ([0.049]; 95% confidence interval 0.494 to 0.686; P<0.0001). For ocular pain scores, the weighted mean (standard error) difference was −4.580 ([1.192]; 95% confidence interval −6.917 to 2.244; P=0.0002). All secondary efficacy results favored OMS302. Specifically, analyses supporting prevention of miosis (patients with ≥6 mm pupil diameter at completion of cortical clean-up and those with <6 mm diameter at any time during surgery) were significant for OMS302 (95.9% versus 77.0% and 9.2% versus 38.0%, respectively; P<0.0001 for each endpoint). OMS302 was well tolerated and not associated with any unexpected adverse events.ConclusionOMS302 maintained mydriasis, prevented miosis, and reduced early postoperative pain when administered in irrigation solution during intraocular lens replacement, with a safety profile similar to that of placebo. OMS302 is preservative-free and bisulfite-free, and its administration does not require any modification to the surgical procedure.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification

Lindstrom¹,

Loden²,

Walters³

et al. 2014

OPTH

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“…The usual topical protocol consists of the combination of cycloplegic (tropicamide 1%) and adrenergic receptor agonist (phenylephrine 2.5%). [ 9 ] It is known that even with topical administration, drug absorption may cause some unwanted systemic side effects. [ 10 11 ]…”

Section: Advances In Pharmacological Pupil Expansionmentioning

confidence: 99%

Cataract surgery in small pupils

Malyugin

2017

Indian J Ophthalmol

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“…Ketorolac 0.45% was found to be superior in its ability to inhibit prostaglandin E2 compared to nepafenac 0.1% and bromfenac 0.09%, which are used in patients undergoing phacoemulsification. Prostaglandin E2 is a mediator of inflammatory signals within the COX pathway and it can also enhance the constrictor action of the iris sphincter through mechanisms that are not dependent on cholinergic receptors 81–83. Ketorolac tromethamine 0.5% was also better than prednisolone acetate 1% solutions in preventing surgically-induced miosis 11…”

Section: Iol Replacement Surgerymentioning

confidence: 99%

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

Grob¹,

González-González²,

Daly³

2014

OPTH

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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.

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The Pharmacotherapy of Cataract Surgery

Cited by 5 publications

References 88 publications

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification

Cataract surgery in small pupils

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

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The Pharmacotherapy of Cataract Surgery

Cited by 5 publications

References 88 publications

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of&nbsp;intraoperative pupil diameter and reduction of&nbsp;postoperative pain in intraocular lens replacement with phacoemulsification

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of&nbsp;intraoperative pupil diameter and reduction of&nbsp;postoperative pain in intraocular lens replacement with phacoemulsification

Cataract surgery in small pupils

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

Contact Info

Product

Resources

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Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification