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Patient considerations in cataract surgery – the role of combined therapy using phenylephrine and ketorolac

机译：白内障手术患者的考虑因素–苯肾上腺素和酮咯酸联合治疗的作用

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Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria?) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients’ quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients’ expectations regarding visual recovery are also increasing.
机译：白内障是导致晶状体光学质量下降，渐进和与年龄有关的白内障，是导致世界范围内可治疗的失明的主要原因。白内障手术是眼科医生最常用的手术方法，并且是治疗白内障的唯一有效方法。外科技术的进步和更好的术后视觉效果已逐渐改变了白内障手术的主要关注点，成为一种经过改进的程序，可产生最佳的屈光效果。白内障摘除过程中充分的散瞳对成功的手术结果至关重要。不良的瞳孔扩张可能会导致严重的威胁视力的并发症，从而显着增加手术成本并降低患者的舒适度。散瞳是使用抗胆碱能药和拟交感神经药获得的。苯肾上腺素，一种α1-肾上腺素能受体激动剂，在通过前房内注射给药时可以有效地扩张瞳孔。另外，非甾体抗炎药（如酮咯酸）可抑制前列腺素的合成，可用于减少术中瞳孔缩小，控制白内障手术相关的疼痛和炎症，并防止术后囊状黄斑水肿的发生。最近，美国食品药品监督管理局已批准将去氧肾上腺素和酮咯酸的新组合（O​​midria ？）用于白内障手术中，以维持术中散瞳，预防瞳孔缩小，减轻术后疼痛和炎症。临床试验表明，这种新的组合是有效的，将两种药物的积极作用与良好的安全性和患者耐受性结合在一起。此外，最近的报道表明，这种组合对瞳孔散大不良风险高的患者也有效。总之，白内障是一个全球性问题，会严重影响患者的生活质量。但是，可以通过安全且微创的手术进行治疗。外科手术技术的进步和诸如苯肾上腺素和酮咯酸的组合等新型药理学试剂，以及更好的人工晶状体，大大改善了视力，因此患者对视力恢复的期望也在增加。

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