Twice-Daily, Preservative-Free Ketorolac 0.45% for Treatment of Inflammation and Pain After Cataract Surgery

Donnenfeld, Eric D.; Nichamin, Louis D.; Hardten, David R.; Raizman, Michael B.; Trattler, William; Rajpal, Rajesh K.; Alpern, Louis; Félix, Carlos Roberto; Bradford, Ronald R.; Villanueva, Linda; Hollander, David; Schiffman, Rhett M.

doi:10.1016/j.ajo.2010.09.003

Cited by 43 publications

(37 citation statements)

References 26 publications

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“…Our results indicate that ketorolac not only decreased the average pain score over time, but also significantly shortened the duration of pain for patients after intravitreal injection. A recent study by Donnenfeld et al (10) showed that ketorolac effectively treated both inflammation and pain following cataract surgery. Nonsteroidal anti-inflammatory agents have also been shown to be effective and safe in the management of pain after femtosecond laser in situ keratomileusis (11) as well as after excimer photorefractive keratectomy (12).…”

Section: The Authors Report No Proprietary Interest or Financial Suppmentioning

confidence: 99%

Shortening Ocular Pain Duration following Intravitreal Injections

Rifkin

Schaal

2012

European Journal of Ophthalmology

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Purpose. To determine ocular pain duration after routine in-office intravitreal injection and to determine whether topical eyedrops are beneficial in increasing patient comfort. Methods. Forty injection-naïve patients receiving routine intravitreal injections of bevacizumab for age-related macular degeneration were randomized into 3 groups: group 1 (control, no drops), group 2 (generic artificial tears), and group 3 (ketorolac tromethamine 0.4% eyedrops). Those who received topical medications were given a Visual Analog Pain score survey and asked to record their pain on a scale from 0 (no distress) to 10 (unbearable distress) daily until a score of 0 was achieved, at which point they were instructed to discontinue use of their given drops. Self-reported pain scores were assessed. Results. Pain after routine intravitreal injection lasts on average between 3 and 7 days. Patients receiving topical ketorolac eyedrops reported the fewest average number of pain days (2.25±1.22) vs patients receiving artificial tears (3.54±1.13) or those who received no postprocedure eyedrops (5.13±1.25); p<0.05. At most, patients receiving ketorolac eyedrops reported 3 days of recordable pain. Those who received artificial tears reported at most 5 days of recordable pain, and patients who did not receive any postprocedure eyedrops reported at most 7 days of recordable pain. Conclusions. Pain after intravitreal injection is generally mild, may be reduced by postinjection topical ketorolac eyedrops, and lasts less than 1 week.

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Section: The Authors Report No Proprietary Interest or Financial Suppmentioning

confidence: 99%

Shortening Ocular Pain Duration following Intravitreal Injections

Rifkin

Schaal

2012

European Journal of Ophthalmology

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“…Ketorolac has been used successfully in the alleviation of ocular inflammation and pain, the prevention and treatment of postoperative cystoid macular edema, and the prevention of intraoperative miosis 7,79–80. Use of twice-daily ketorolac 0.45% for 16 days beginning 1 day before surgery resulted in a greater percentage of patients with an ocular inflammatory score of 0 on day 14 (52.5% compared to 26.5% in the vehicle group) and a greater number of patients with a pain score of 0 on day 1 postoperatively (72.4% versus 39.7%, respectively) 79. Topically, it is available in 0.4%, 0.5%, and 0.45% concentrations (ACULAR LS ® , ACULAR ® , and ACUVAIL ® ; Allergan, Inc., Irvine, CA, USA).…”

Section: Iol Replacement Surgerymentioning

confidence: 99%

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

Grob¹,

González-González²,

Daly³

2014

OPTH

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Abstract:The maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this combination have demonstrated statistically significant differences when compared to placebo in maintaining intraoperative mydriasis (P0.00001) and in reducing pain in the early postoperative period (P=0.0002). This medication may be of benefit for use in cataract and lens replacement surgery in the near future.

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“…In an effort to increase ocular bioavailability, a new formulation of ketorolac was developed to preserve the efficacy of prior formulations, while enhancing tolerability with a less frequent dosing regimen 21. Compared with the ketorolac 0.4% formulation, the concentration of Acuvail is 12% greater (0.45%) and carboxymethylcellulose is added to the emulsion to allow greater drug retention on the ocular surface and improve comfort and drug penetration.…”

Section: Pharmacology Of Ketorolacmentioning

confidence: 99%

“…The efficacy of Acuvail was assessed in two identical multicenter, double-masked, randomized, placebo-controlled, parallel studies and specifically conducted to evaluate the effects of Acuvail on relief of pain and inflammation after cataract surgery 21. The results of these parallel studies were analyzed together and collectively involved 511 patients.…”

Section: Efficacy Studiesmentioning

confidence: 99%

“…5–21 Ketorolac 0.5% (Acular ® , Allergan Inc, Irvine, CA) is approved by the Food and Drug administration (FDA) for seasonal allergic conjunctivitis, inflammation following cataract surgery, and ocular discomfort after refractive surgery 22. To reduce the incidence of burning and stinging, a 0.4% concentration of ketorolac (Acular LS ® , Allergan Inc) was formulated, and appears to have a similar therapeutic effect 18,23.…”

Section: Introductionmentioning

confidence: 99%

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Critical appraisal of ophthalmic ketorolac in treatment of pain and inflammation following cataract surgery

Reddy

Kim²

2011

OPTH

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Background:The purpose of this review was to provide a critical appraisal of the literature supporting the efficacy of ophthalmic ketorolac (Acuvail®) in the treatment of pain and inflammation after cataract surgery.Methods:Literature search and expert opinion of the authors.Results:Recent studies indicate greater intraocular drug levels in the anterior chamber and iris-ciliary body after topical application of Acuvail in comparison with older formulations of ketorolac. A large randomized, multicenter, placebo-controlled study demonstrated significantly less inflammation and pain after cataract surgery using Acuvail.Conclusion:Acuvail appears to be effective in reducing post-cataract surgery pain and inflammation.

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Twice-Daily, Preservative-Free Ketorolac 0.45% for Treatment of Inflammation and Pain After Cataract Surgery

Cited by 43 publications

References 26 publications

Shortening Ocular Pain Duration following Intravitreal Injections

Shortening Ocular Pain Duration following Intravitreal Injections

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

Critical appraisal of ophthalmic ketorolac in treatment of pain and inflammation following cataract surgery

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