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Omidria reduces cataract surgery time, complications

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NEW ORLEANS — Intracameral phenylephrine combined with ketorolac during cataract surgery was associated with a significantly lower complication rate than epinephrine injection, a speaker told colleagues here.

“Intracameral phenylephrine/ketorolac administration, when compared to intracameral epinephrine in routine cataract surgery, was associated with a statistically significant reduction in use of pupillary mydriatic-assist devices, a decrease in intraoperative and postoperative complications, improvement in uncorrected visual acuity postop day 1 and a decrease in overall procedural time,” Eric Rosenberg, DO, MSE, said at the American Society of Cataract and Refractive Surgery meeting.

Omidria (phenylephrine 1%/ketorolac 0.3%, Omeros) is the first intracameral FDA-approved medication for routine use in cataract surgery, Rosenberg said.

The study included 641 cataract procedures; 260 procedures were performed with phenylephrine/ketorolac, and 381 were performed with intracameral epinephrine 1 mg/mL.

All patients received preoperative NSAIDs; 45 patients required the use of a Malyugin ring or hooks.

Duration of surgery was 15.5 minutes in the phenylephrine/ketorolac group and 16.7 minutes in the epinephrine group.

The complication rate was in 4.5% in the epinephrine group and 1.1% in the phenylephrine/ketorolac group. The difference was statistically significant (P = .018).

The complication rate was 11.1% among patients who required rings or hooks and 2.5% among those who did not require devices during cataract surgery. The difference was statistically significant (P = .001).

Complications occurred in 13.3% of epinephrine patients who required rings or hooks, 6.7% of phenylephrine/ketorolac patients who required rings or hooks, 3.7% of epinephrine patients who did not require rings or hooks, and 0.8% of phenylephrine/ketorolac patients who did not require rings or hooks.

Mean uncorrected visual acuity was similar in both groups at 1 month. However, UCVA was significantly better in the phenylephrine/ketorolac group on postoperative day 1 (P = .003). – by Matt Hasson and Patricia Nale, ELS

Reference:

Rosenberg E, et al. Initial experience, visual outcomes and efficacy of intracameral phenylephrine and ketorolac (1%/0.3%) during cataract surgery. Presented at: American Society of Cataract and Refractive Surgery meeting; May 6-10, 2016. New Orleans.

Disclosure: Rosenberg reports no relevant financial disclosures. Co-author Donnenfeld reports he is a consultant for Omeros.