Abstract
Purpose To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. Methods This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. Results Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. Conclusion Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.
Highlights
Cataract surgery requires sufficient mydriasis, to facilitate capsulorhexis or capsulotomy, phacoemulsification, and intraocular lens insertion
A published study from our department that evaluated the effect of 3 femtosecond laser platforms after femtosecond laser-assisted cataract surgery (FLACS) pretreatment on pupil diameter revealed significant pupillary miosis which was independent to the laser platform used [6], It is hypothesized that pupillary miosis is associated with prostaglandin release in the anterior chamber (AC) and with the dissipation of laser energy around the iris tissue [5, 6]
It seems that the intraocular manipulations during cataract surgery cause breakdown of the blood-aqueous barrier promoting an inflammatory cascade with the release of prostaglandins by ciliary body [12,13,14,15]. e topical use of NSAIDs inhibits the synthesis of prostaglandins in the AC and thereby minimizes the likelihood of pupillary miosis [16,17,18]
Summary
Cataract surgery requires sufficient mydriasis, to facilitate capsulorhexis or capsulotomy, phacoemulsification, and intraocular lens insertion. Recent studies have demonstrated that short-term topical NSAIDs as a pretreatment prior to FLACS results in less prostaglandin release in the AC [9], and NSAID pretreatment seems to induce significantly less pupillary miosis when compared to the eyes that did not receive NSAID prior to FLACS [10, 11]. E following study will assess aqueous humor prostaglandin E2 (PGE2) concentrations after FLAC (lens fragmentation may influence the inflammatory response and prostaglandin production due to cataract density disparities between the eyes) in patients who were pretreated with topical ketorolac compared with patients who did not receive NSAID pretreatment Recent studies have demonstrated that short-term topical NSAIDs as a pretreatment prior to FLACS results in less prostaglandin release in the AC [9], and NSAID pretreatment seems to induce significantly less pupillary miosis when compared to the eyes that did not receive NSAID prior to FLACS [10, 11]. e patients in the study assessing prostaglandin quantification in the AC
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