Preoperative ketorolac tromethamine 0.4% in phacoemulsification outcomes: pharmacokinetic-response curve.
OBJECTIVE
To assess the clinical benefit, relative efficacy, and pharmacokinetic-response curve of preoperative and postoperative ketorolac tromethamine 0.4% (Acular LS) to improve outcomes during and after cataract surgery.


METHODS
Private clinical practice.


METHODS
One hundred patients were randomized in a double-masked fashion to 4 groups of 25 to receive ketorolac for 3 days, 1 day, or 1 hour or a placebo before phacoemulsification. All treatment groups received ketorolac 0.4% for 3 weeks postoperatively; the placebo group received vehicle. Outcomes measures were preservation of preoperative mydriasis, phacoemulsification time and energy, operative time, corneal clarity, endothelial cell counts, postoperative inflammation, intraoperative and postoperative discomfort, complications, and incidence of clinically significant cystoid macular edema (CME).


RESULTS
Maintenance of pupil size with 3-day ketorolac dosing was significantly better than with 1-day dosing (P<.01), which was significantly better than with 1-hour or placebo dosing (P<.01). Both 3-day and 1-day dosing were superior to 1-hour or placebo dosing. No patient receiving ketorolac 0.4% for 1 or 3 days developed CME compared with 12% of patients in the control (placebo) group and 4% in the 1-hour group. Three-day and 1-day dosing of ketorolac reduced surgical time, phacoemulsification time and energy, and endothelial cell loss and improved visual acuity in the immediate postoperative period compared with 1-hour predosing and the placebo (P<.05).


CONCLUSIONS
The preoperative use of ketorolac tromethamine 0.4% for 3 days followed by 1-day of predosing provided optimum efficacy and superior outcomes relative to 1-hour pretreatment and a placebo.
Donnenfeld
Eric D
ED
eddoph@aol.com
Perry
Henry D
HD
Wittpenn
John R
JR
Solomon
Renée
R
Nattis
Alanna
A
Chou
Timothy
T
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002452:Cell Count; D003315:Cornea / Q000502:physiology; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000166:cytology; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D009883:Ophthalmic Solutions / Q000493:pharmacokinetics / Q000627:therapeutic use; D010149:Postoperative Pain; D018918:Phacoemulsification; D011300:Preoperative Care; D011680:Pupil / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions; D020911:Ketorolac Tromethamine