Ketorolac plus tobramycin/dexamethasone versus tobramycin/dexamethasone after uneventful phacoemulsification surgery: a randomized controlled trial.
OBJECTIVE
To evaluate the benefit of adding a nonsteroid agent to an antibiotic/steroid combination after uneventful phacoemulsification, adopting a weekly follow-up, to gain insight into the optimal duration of postoperative treatment and to examine whether risk factors for inflammation exist.


METHODS
Patients were randomized to (i) tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d. (n = 72), and (ii) a combination of tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d., plus ketorolac tromethamine 0.5%, 1 drop t.i.d. (n = 73). On days 7, 14, 21 and 28, the frequency of inflammation-related signs (corneal edema, conjunctival hyperemia, anterior chamber or Tyndall reaction) as well as best-corrected visual acuity (BCVA) were measured. On day 21, logistic regression was performed to evaluate risk factors for inflammation.


RESULTS
The frequency of inflammation-related signs did not differ between the 2 groups at any time point, neither did BCVA. On day 21, pseudoexfoliation was associated with the presence of any inflammation-related sign (OR = 4.5; 95% CI: 1.2-16.0; p = 0.022). No evidence of clinically significant cystoid macular edema became evident in either group.


CONCLUSIONS
The addition of ketorolac did not seem to offer any additional benefit in terms of inflammation-related signs. Four weeks appeared as an adequate treatment interval. Special attention should be paid to patients with pseudoexfoliation.
Chatziralli
Irini P
IP
Department of Ophthalmology, Veroia General Hospital, 28 Papanastasiou Street, Veroia, Greece. eirchat@yahoo.gr
Papazisis
Leonidas
L
Sergentanis
Theodoros N
TN
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D015715:Corneal Edema / Q000175:diagnosis / Q000517:prevention & control; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000517:prevention & control; D020910:Ketorolac / Q000008:administration & dosage*; D008297:Male; D018918:Phacoemulsification; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D014031:Tobramycin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D003907:Dexamethasone; D014031:Tobramycin; D020910:Ketorolac