title: Preoperative ketorolac tromethamine 0.4% in phacoemulsification outcomes: pharmacokinetic-response curve.
abstract: 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.
authors.affiliation: eddoph@aol.com
authors.forename: Eric D
authors.initials: ED
authors.lastname: Donnenfeld
authors.forename: Henry D
authors.initials: HD
authors.lastname: Perry
authors.forename: John R
authors.initials: JR
authors.lastname: Wittpenn
authors.forename: Renée
authors.initials: R
authors.lastname: Solomon
authors.forename: Alanna
authors.initials: A
authors.lastname: Nattis
authors.forename: Timothy
authors.initials: T
authors.lastname: Chou
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions; D020911:Ketorolac Tromethamine