A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients.

PURPOSE: To evaluate whether adding perioperative topical ketorolac tromethamine 0.4% improves cataract surgery outcomes relative to topical steroids alone in patients without known risk factors for cystoid macular edema (CME). DESIGN: Prospective, randomized, investigator-masked, multicenter clinical trial. METHODS: Patients scheduled to undergo phacoemulsification and with no recognized CME risks (diabetic retinopathy, retinal vascular disease, or macular abnormality) were randomized to receive either prednisolone acetate 1% 4 times daily (QID) alone (steroid group; n = 278) or prednisolone 1% QID plus ketorolac 0.4% QID (ketorolac/steroid group; n = 268) for approximately four weeks postoperatively. In the ketorolac/steroid group, patients also received topical ketorolac 0.4% QID for three days preoperatively. In both groups, patients received four doses of ketorolac 0.4% one hour before surgery. Patients with capsular disruption or vitreous loss intraoperatively were exited from the study. Outcome measures included CME incidence, retinal thickness as measured by optical coherence tomography (OCT), best-corrected visual acuity, and contrast sensitivity. RESULTS: No patients in the ketorolac/steroid group and five patients in the steroid group had clinically apparent CME (P = .032). Based on OCT, no ketorolac/steroid patient had definite or probable CME, compared with six steroid patients (2.4%; P = .018). In the ketorolac/steroid group, mean retinal thickening was less (3.9 microm vs 9.6 microm; P = .003), and fewer patients had retinal thickening of more than 10 microm as compared with the steroid group (26% vs 51%; P < .001). CONCLUSIONS: This study suggests that adding perioperative ketorolac to postoperative prednisolone significantly reduces the incidences of CME and macular thickening in cataract surgery patients already at low risk for this condition.

Characterization of visual phenomena with the Array multifocal intraocular lens.

PURPOSE: To characterize the visual sensations reported after bilateral implantation of the Array multifocal intraocular lens (IOL) (Allergan Surgical) and evaluate the means to mitigate unwanted visual sensations. SETTING: Surgery centers in Kansas City, Missouri, and Lake Worth, Florida, USA. METHODS: A retrospective parallel-group assessment of subjective nighttime visual sensations was conducted in 22 patients who had bilateral implantation of the Array multifocal IOL. Thirteen patients were recruited from a small subset of patients who were dissatisfied with the Array because of unwanted visual sensations (UVS group). The parallel group included 9 patients who were satisfied with the Array and not bothered by visual sensations (satisfied group). The primary endpoint was the patient's characterization of visual phenomena under simulated nighttime conditions. The secondary endpoint was the effect of adding trial lenses of -0.50 diopter (D) and -1.00 D to the patient's distance spectacle correction. RESULTS: Most patients reported that the simulation produced visual sensations similar to their real-life experiences. Patients in the UVS group reported the visual sensations as large starbursts and somewhat spoke-like starbursts with fine lines. Patients in the satisfied group reported them as blurred large or small starbursts. A few reported a color variance and finer quality to the starburst in real life. Visual phenomena were generally mitigated by the addition of a -0.50 D or -1.00 D lens. CONCLUSIONS: Both study groups reported similar visual phenomena. The difference between those who were bothered by the visual sensations and those who were not appears to be a function of individual tolerance. The visual sensations may be mitigated with minus-lens overcorrection.