What phenylephrine/ketorolac injection means for preoperative cataract regimen

The approval of intracameral phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros Corp.) could have implications for preoperative management and potentially postoperative management as well, according to John R. Wittpenn, MD, Ophthalmic Consultants of Long Island. While the FDA study evaluated pain and maintenance of pupillary dilation pertaining to intraoperative use of Omidria, the findings hint at additional benefits.

READ MORE: How this newly approved drug aims to treat intraoperative miosis, reduce pain

“I think that Omidria in the intraoperative solution will negate the need for the preoperative nonsteroidals, and I’m hopeful, although there is no data yet, that it may even improve our postoperative course,” Dr. Wittpenn said. “I suspect that we’ll still need to use nonsteroidals to prevent macular swelling and speed up resolution of inflammation, but I’m hopeful that we’ll be able to use them for shorter times and perhaps at lower doses.”

The FDA study showed that intraoperative Omidria does as well at maintaining pupillary dilation and avoiding pain as all of the earlier studies looking at topical nonsteroidals.

“I think the data is pretty clear in the FDA study that Omidria will certainly get us during surgery the same things we were attempting to get with the preoperative nonsteroidals used topically,” he said.

The impact of Omidria on postoperative care has not yet been studied.

“That will be looked at in the future. I’m hopeful that we may find that the intraoperative use of the Omidria will reduce our need for nonsteroidals postoperatively in terms of either dosing frequency or even duration of use. Appropriate studies will need to be done once we have access to this new method of delivering a nonsteroidal into the eye,” Dr. Wittpenn said.