Continuous intracameral phenylephrine-ketorolac irrigation for miosis prevention in femtosecond laser-assisted cataract surgery: Reduction in surgical time and iris manipulation

J Cataract Refract Surg. 2019 Apr;45(4):465-469. doi: 10.1016/j.jcrs.2018.11.004. Epub 2019 Jan 17.


Purpose: To determine whether the addition of phenylephrine 1.0%-ketorolac 0.3% (Omidria) to the irrigation solution during femtosecond laser-assisted cataract surgery (FLACS) reduces surgical time and the need for pupil expansion devices compared with the irrigation solution containing epinephrine.

Setting: Wake Forest Baptist Eye Center, Winston-Salem, North Carolina, USA.

Design: Retrospective case series.

Methods: Data were collected from consecutive patients. One group had epinephrine 1 μg/mL in the irrigating solution and the other group, had phenylephrine and ketorolac 4 mL added to 500 mL irrigation solution instead of epinephrine. All patients received preoperative topical bromfenac 2 days before surgery. The same surgeon performed all procedures using the same laser (Catalys) and operative conditions. Endpoints were surgical time and the use of pupil expansion devices.

Results: Data were collected from 200 consecutive patients, 100 in each group. Patient demographics, including a mean baseline pupil size of 7.1 mm, were similar between the groups. Mean surgical times were significantly reduced in the phenylephrine-ketorolac group versus the epinephrine group (8.1 minutes versus 9.4 minutes) (P = .007). When eyes requiring a pupil expansion device were eliminated, there was still a significant reduction in surgical time for phenylephrine-ketorolac versus epinephrine (8.1 minutes versus 9.0 minutes) (P = .018). Two eyes (2%) in the phenylephrine-ketorolac group and 12 eyes (12%) in the epinephrine group required a pupil expansion device (P = .009).

Conclusion: These data support the hypotheses that using phenylephrine and ketorolac reduces FLACS time and the need for pupil expansion devices.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-1 Receptor Agonists / administration & dosage
  • Aged
  • Aged, 80 and over
  • Anterior Chamber / drug effects*
  • Cataract Extraction / methods*
  • Cyclooxygenase Inhibitors / administration & dosage
  • Drug Therapy, Combination
  • Female
  • Humans
  • Ketorolac / administration & dosage*
  • Laser Therapy / methods*
  • Male
  • Middle Aged
  • Miosis / prevention & control*
  • Operative Time
  • Phenylephrine / administration & dosage*
  • Retrospective Studies
  • Therapeutic Irrigation*


  • Adrenergic alpha-1 Receptor Agonists
  • Cyclooxygenase Inhibitors
  • Phenylephrine
  • Ketorolac