Effects of Short-term Preoperative Topical Ketorolac on Pupil Diameter in Eyes Undergoing Femtosecond Laser–Assisted Capsulotomy

Abstract

Short-term topical use of ketorolac prior to femtosecond laser-assisted cataract surgery seems to induce significantly less pupillary miosis in comparison to eyes that did not receive NSAID pretreatment. NSAID use is advised prior to femtosecond laser-assisted cataract surgery to minimize pupil miosis-related surgical difficulties or complications during cataract extraction. [J Refract Surg. 2017;33(4):230-234.].

Femtosecond laser-assisted cataract surgery in a public teaching hospital setting

“…Although we did not test other modules on the Z8, it can also be used for refractive surgery and keratoplasty which could be beneficial when sharing the device among other departments in a comprehensive ophthalmic teaching center. Moreover, studies have shown pupil miosis after femtosecond laser application during FLACS [ 24 , 25 ]. However, in our study, we did not use any preoperative non-steroidal anti-inflammatory eye drops and still did not find significant pupil miosis.…”

The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E2 Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy

“…The topical use of NSAIDs inhibits the synthesis of prostaglandins in the AC and thereby minimizes the likelihood of pupillary miosis [ 16 – 18 ]. A recent study from our institute demonstrated that patients receiving a 3-day topical regimen of ketorolac prior to FLAC better retained their mydriasis after the laser treatment [ 10 ]. Furthermore, a study by Schultz et al showed that the use of topical NSAIDs (diclofenac) prior to FLACS reduced prostaglandin release in the AC [ 9 ].…”

“…Furthermore, a study by Schultz et al showed that the use of topical NSAIDs (diclofenac) prior to FLACS reduced prostaglandin release in the AC [ 9 ]. In the study mentioned above, the authors performed FLACS treatment that included capsulotomy creation and lens fragmentation, while diclofenac was used as an NSAID agent treatment at the day of surgery [ 9 ], while in our previous study, only FLACS capsulotomy was performed (to better control the study parameters) and ketorolac was used prior to surgery [ 10 ].…”

“…The pretreatment with femtosecond laser-assisted cataract surgery (FLACS) platforms during cataract surgery has been associated with pupillary miosis [ 4 – 6 ]; the latter has been attributed to the increase of inflammatory mediator (prostaglandins) concentration in the anterior chamber (AC) after FLACS [ 7 , 8 ]. Recent studies have demonstrated that short-term topical NSAIDs as a pretreatment prior to FLACS results in less prostaglandin release in the AC [ 9 ], and also NSAID pretreatment seems to induce significantly less pupillary miosis when compared to the eyes that did not receive NSAID prior to FLACS [ 10 , 11 ]. The patients in the study assessing prostaglandin quantification in the AC received both capsulotomy and lens fragmentation during FLACS [ 9 ], while the NSAID used was diclofenac [ 9 ].…”

Inflammation management in ophthalmology: new evidences for cataract surgery and beyond

“…Uno studio simile, condotto con ketorolac in 42 pazienti sottoposti a chirurgia della cataratta con femto-laser, ha ottenuto risultati del tutto sovrapponibili, rilevando una miosi Fig. 9 -Confronto tra il diametro pupillare osservato durante l'intervento chirurgico nei gruppi trattati con nepafenac o tobramicina/desametasone (modificata da [10]) TABELLA 3 -Eventi avversi registrati nei pazienti trattati con bromfenac o placebo (modificata da [11] inferiore nei pazienti sottoposti a un breve trattamento topico prima dell'intervento rispetto ai controlli non trattati [14]. Dall'insieme degli studi disponibili in letteratura emerge che tutti i FANS, se somministrati prima dell'intervento, sono efficaci nel mantenere la midriasi durante la chirurgia della cataratta.…”