Effect of topical ketorolac tromethamine and topical nepafenac on maintaining pupillary dilation during phacoemulsification

Abstract

Objective: This study compared the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification.

Methods: This is a prospective, randomized, double-masked comparative study involving adult cataract patients given topical NSAIDs (ketorolac or nepafenac) or balanced salt solution (control) prior to phacoemulsification and capsular bag intraocular-lens (IOL) implantation at a tertiary hospital. Horizontal and vertical diameters of pupil were measured at different stages of cataract surgery and the mean values were compared across the three groups.

Results: A total of 47 eyes of 44 cataract surgery patients, 13 males and 34 females, with a mean age of 66.04 ± 8.87 years, were included in the study. The mean horizontal and vertical diameters of the three groups were similar at the start of surgery. Significant differences were seen after IOL implantation, with the nepafenac group having the largest mean diameters in both horizontal (p = 0.012) and vertical (p = 0.012) pupil measurements.

Conclusion: Topical nepafenac has been shown to be a more effective inhibitor of miosis during phacoemulsification and provides a more stable mydriatic effect throughout the surgical procedure compared to topical ketorolac and placebo.