Cataract Clinical Trial
Official title:
Nepafenac Versus Ketorolac Eye Drops in Prevention of Intraoperative Miosis During Cataract Surgery
This study aim at determining the efficacy of Nepafenac and Ketorolac in obtaining adequate intraoperative mydriasis and preventing miosis during cataract surgery. It also compare the efficacy of both Nepafenac versus Ketorolac, and determine the more effective agent in preventing miosis during cataract surgery. The investigators try to determine if the effect of preoperative NSAIDs agents use would show a financial benefit, or this manoeuvre would add a financial load on the patients who are candidate for cataract surgery.
Maintaining adequate mydriasis is one of the most important prerequisites during both
extracapsular cataract extraction and phacoemulsification intervention. The importance of
intraoperative maintenance of mydriasis arises from the necessity for the surgeon to insert
intra-ocular lens in the posterior chamber of the eye. It is now well established that
non-steroidal anti-inflammatory drugs (NSAIDs) reduce intraoperative miosis during cataract
surgery. Topical Flurbiprofen, Indomethacin and Diclofenac with and without intraoperative
epinephrine are the commonest topical non-steroidal eye drops with which nearly all
publications in the literature studied the prevention of intraoperative surgery-induced
miosis. In addition, Diclofenac was found to be the most effective NSAIDs agent in
maintaining intraoperative mydriasis.
More recently, evidence that some NSAIDs, namely ketorolac and Flurbiprofen, may have a role
in preventing pseudophakic cystoid macular oedema.
Patients whom eyes are pre-treated with some NSAIDs, especially diclofenac, shows a
statistically significant reduction in the degree of postoperative inflammation (e.g.,
redness, pain and itching) on the first post-operative day. On the contrary, Thaller et al
found, in his study at 2000, that no statistically significant difference in the
postoperative redness, pain and cells in the anterior chamber.
Administration of Adrenalin in the anterior chamber fluid is found by several studies to be
more effective in maintaining intraoperative mydriasis than preoperative treatment with
NSAIDs.
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