Optimizing pain management and pupil dilation in cataract surgery: a systematic review and meta-analysis of phenylephrine/ketorolac (OMIDRIA®)
<h3>Purpose</h3><p dir="ltr">This systematic review and meta-analysis aims to evaluate the efficacy and safety of the combination of phenylephrine 1% and ketorolac 0.3% (OMIDRIA®) for optimizing pain management and maintaining pupil dilation during cataract surgery. Compa...
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2025
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| Summary: | <h3>Purpose</h3><p dir="ltr">This systematic review and meta-analysis aims to evaluate the efficacy and safety of the combination of phenylephrine 1% and ketorolac 0.3% (OMIDRIA®) for optimizing pain management and maintaining pupil dilation during cataract surgery. Comparisons were made against placebo/vehicle, phenylephrine alone, and epinephrine.</p><h3>Methods</h3><p dir="ltr">A comprehensive search of PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science was conducted. Eligible studies were randomized clinical trials and observational studies assessing intracameral phenylephrine/ketorolac against control groups. Key outcomes included pain management, pupil diameter, and adverse events. Data were synthesized using meta-analysis with fixed and random-effects models, and heterogeneity was assessed using the I<sup>2</sup> statistic.</p><h3>Results</h3><p dir="ltr">Ten studies, including 220,061 patients, were analyzed. The combination of phenylephrine/ketorolac significantly reduced postoperative pain (RR = 0.72, 95% CI: 0.60–0.86) and opioid use (RR = 0.45, 95% CI: 0.23–0.89) compared to vehicle and epinephrine. PE/K also maintained a larger pupil diameter (MD = 0.54 mm, 95% CI: 0.32–0.75) with minimal heterogeneity (I<sup>2</sup> = 0%) and reduced the incidence of severe pain (RR = 0.41, 95% CI: 0.27–0.63). No significant differences in adverse events such as elevated intraocular pressure, inflammation, or headaches were observed.</p><h3>Conclusion</h3><p dir="ltr">Phenylephrine/ketorolac (OMIDRIA®) demonstrates superior efficacy in maintaining intraoperative mydriasis, reducing postoperative pain, and minimizing opioid use without increasing adverse events. This combination offers a preferable alternative to traditional agents, potentially setting a new standard for pain management and pupil dilation in cataract surgery.</p><h2>Other Information</h2><p dir="ltr">Published in: Graefe's Archive for Clinical and Experimental Ophthalmology<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s00417-025-06811-y" target="_blank">https://dx.doi.org/10.1007/s00417-025-06811-y</a></p> |
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