Ketorolac Eyedrops Research Articles

Neurotrophic Keratopathy after wide retinal endolaser and postoperative Ketorolac eye drops: A case series.

We report a series of 5 cases, happened in a period of 5 months, who developed neurotrophic keratopathy (NK) following pars plana vitrectomy (PPV) and retinal endolaser for rhegmatogenous retinal detachment (RRD). In our several decennary experience of surgical center predominantly based on vitreoretinal surgery, we had rare cases of postoperative NK. These recent cases of post-surgical NK happened contextually to our change of postoperative non-steroidal anti-inflammatory drugs (NSAIDs) drops, based on Ketorolac Tromethamine 0.5% eye drops. Five patients with a mean age of 61 ± 7.3 years were treated with one or more PPV with intraoperative peripheral endolaser for RRD. Nobody had previous herpetic keratitis, systemic disease like diabetes mellitus or other predisposing factors for NK. In the postoperative period, all patients received Ketorolac Tromethamine 0.5% eye drops for a mean period of 54 ± 25 days. During follow-up visits they developed NK and they were successfully treated with suspension of Ketorolac eye drops, application of therapeutic contact lens or amniotic membrane patch and topical lubricant therapy. Postoperative Ketorolac eye drops, in patients who underwent PPV with endolaser, may reduce the corneal sensitivity, predispose to epithelial disruption and NK development. Studies are needed to explore the effect of NSAIDs on corneal sensitivity reduction in patient who will undergo PPV and extensive endolaser.

Efeitos do colírio de cetorolaco de trometamol sobre o hemograma, a bioquímica sérica e a urinálise em cães saudáveis

ABSTRACT This study aimed to evaluate whether the use of trometamol ketorolac for 30 consecutive days may change the blood count, the serum biochemistry profile, and the urinalysis of healthy dogs. Eleven small breed dogs (4.6-10kg), with ages ranging from 1 to 9 years were enrolled in the study. Dogs received 40μL of 0.4% trometamol ketorolac eye drops, every 12 h in both eyes for 30 consecutive days. Blood and urine samples were collected at baseline, and following 15 and 30 days of the beginning of the treatment. Creatinine levels increased significantly at day 15 (1.21±0.1mg/dL) and 30 (1.22±0.1mg/dL) when compared with baseline (0.94±0.1mg/dL) (P<0.01). Significantly increased values of serum potassium were observed only at day 30 (4.66±0.15mEq/L), when compared with day 15 (4.32±0.12mEq/L) and baseline (4.36±0.15mEq/L) (P<0.05). The other hematological and biochemical parameters did not change significantly during the study (P>0.05). From observations of our study, it can be concluded that the instillation of trometamol ketorolac for 30 consecutive days did not cause clinically relevant changes in the blood count, biochemistry profile and in the urinalysis of healthy dogs.

Preformulation-Assisted Design of Ketorolac Tromethamine for Effective Ophthalmic Delivery.

Background: The eye is a highly protected organ from ocularly administered drugs; drug- and formulation-related factors contribute significantly to ocular bioavailability. There has been a growing interest in using nonsteroidal anti-inflammatory drugs in ophthalmology for treating postoperative pain, inflammation, and seasonal allergic conjunctivitis. A preformulation-assisted design boosts efficacy and reduces dose requirements. Methods: This work aims to study the preformulation characteristics of ketorolac tromethamine to improve ocular performance and future formulation development through developing an high-performance liquid chromatography (HPLC) stability-indicating assay, forced degradation under stress conditions, solubility, as well as partition and distribution coefficient measurements. An isocratic HPLC with diode array detector method was developed and validated. Accelerated degradation under different stressors (acid, alkali, heat, and oxidative) was studied. In addition, solubility, partition, and distribution were investigated at different pHs of 3.5-7.4. Results: The results indicated that the developed HPLC method was simple, rapid (retention time ≃3 min), sensitive, selective, robust, and stability indicating. The drug seems more chemically sensitive to acid degradation (∼30% and 40% of the drug was degraded under 0.1 M and 1 M HCl at 60°C for 24 h, respectively). Another significant degradation was recorded in the following order: Oxidative > alkali > heat (phosphate-buffered saline) > heat (distilled water). Being a weak ionizable drug, both water and lipid solubility, as measured through partition coefficients, it demonstrated pH-dependency. Conclusion: For the optimum balance of water and lipid solubility required for penetration through the lipophilic corneal epithelial barrier, ketorolac eye drops would be better formulated between pH 5.5 and 6.6 than being formulated at the physiological fluid pH 7.4, where the drug is extremely hydrophilic and less permeable.

Study of Cost-effectiveness and Safety of 0.2% Olopatadine in Comparison with Combination of 0.1% Olopatadine and 0.4% Ketorolac Eye Drops in Vernal Keratoconjunctivitis among Rural Population

The study aimed to compare the cost-effectiveness and safety of 0.2% Olopatadine with a combination of 0.1% Olopatadine and 0.4% Ketorolac eye drops in Vernal keratoconjunctivitis (VKC) among the rural population. This was a randomized, open-label, prospective study conducted on 129 patients who were diagnosed with VKC. All the patients were randomly allotted to 2 treatment groups. Group 1 received 0.2% Olopatadine eye drops/single drops/three times a day. Group 2 treated with a combination of 0.1% Olopatadine and 0.4% Ketorolac eye drops/single drops/two times a day for four weeks. The patients were advised to follow up during the study period in the second and fourth weeks. During the follow-ups, post-intervention cure rate, adverse drug reactions (ADR) monitoring, and cost-effectiveness of both the drugs were evaluated. A statistically significant (p<0.05) reduction of clinical symptoms was observed in both groups after four weeks of treatment. In 0.2% Olopatadine intervention, 9 cases of ADR were reported out of the 62 patients. Furthermore, treatment with a combination of 0.1% Olopatadine and 0.4% Ketorolac has shown 12 cases from 58 having ADR. Our study revealed that the 0.2% Olopatadine eye drops were a comparatively affordable choice since the cost was less. Therefore, 0.2% Olopatadine is considered a better drug choice in the given scenario of the rural population regarding their safety and cost-effectiveness.

Nepafenac Versus Ketorolac Eye Drops in Prevention of Intraoperative Miosis During Cataract Surgery

Nepafenac Versus Ketorolac Eye Drops in Prevention of Intraoperative Miosis During Cataract Surgery

What is the best treatment for viral conjunctivitis?

EVIDENCE-BASED ANSWER Dexamethasone/povidone-iodine eye drops decrease patient perception of the duration of viral conjunctivitis by 2.6 days compared with artificial tears, at the expense of more stinging (SOR: B, single RCT). Ketorolac eye drops offer no clinically significant benefits compared with artificial tears (SOR: A, consistent RCTs).

A randomised controlled trial of ranibizumab with and without ketorolac eyedrops for exudative age-related macular degeneration

AimsTo evaluate whether ketorolac eyedrops and ranibizumab intravitreal injections would provide additional benefit over ranibizumab alone in the treatment of choroidal neovascularisation (CNV).MethodsThis was a pilot study of eyes with...

Shortening Ocular Pain Duration following Intravitreal Injections

To determine ocular pain duration after routine in-office intravitreal injection and to determine whether topical eyedrops are beneficial in increasing patient comfort. Forty injection-naïve patients receiving routine intravitreal injections of bevacizumab for age-related macular degeneration were randomized into 3 groups: group 1 (control, no drops), group 2 (generic artificial tears), and group 3 (ketorolac tromethamine 0.4% eyedrops). Those who received topical medications were given a Visual Analog Pain score survey and asked to record their pain on a scale from 0 (no distress) to 10 (unbearable distress) daily until a score of 0 was achieved, at which point they were instructed to discontinue use of their given drops. Self-reported pain scores were assessed. Pain after routine intravitreal injection lasts on average between 3 and 7 days. Patients receiving topical ketorolac eyedrops reported the fewest average number of pain days (2.25±1.22) vs patients receiving artificial tears (3.54±1.13) or those who received no postprocedure eyedrops (5.13±1.25); p<0.05. At most, patients receiving ketorolac eyedrops reported 3 days of recordable pain. Those who received artificial tears reported at most 5 days of recordable pain, and patients who did not receive any postprocedure eyedrops reported at most 7 days of recordable pain. Pain after intravitreal injection is generally mild, may be reduced by postinjection topical ketorolac eyedrops, and lasts less than 1 week.

Angiographically silent cystoid macular oedema secondary to paclitaxel therapy

Bilateral macular oedema is an uncommon side‐effect of paclitaxel administration in oncological patients. We report the case of a 64‐year‐old man who presented with decreased visual acuity due to bilateral macular oedema after paclitaxel administration for lung cancer. Optical coherence tomography scans of both eyes revealed cystoid macular oedema. Fluorescein angiography demonstrated the unusual finding of the absence of localised retinal capillary leakage. Ketorolac eye drops and acetazolamide tablets were prescribed and one month later the cystoid macular oedema resolved with subsequent improvement in visual acuity. This case illustrates the unusual presentation of cystoid macular oedema induced by paclitaxel.

Efficacy and Tolerability of Preservative-Free and Preserved Diclofenac and Preserved Ketorolac Eyedrops After Cataract Surgery

To compare the anti-inflammatory efficacy and subjective tolerability of preservative-free and preserved diclofenac 0.1% and preserved ketorolac 0.5% eye drops for prophylaxis and management of inflammation after cataract surgery. Prospective, randomized, investigator-masked, parallel-group, comparative clinical trial. One hundred two patients who underwent small-incision phacoemulsification cataract surgery in an institutional setting were assigned randomly to receive preservative-free diclofenac sodium 0.1% (Voltaren ophtha SDU; Novartis Pharma), preserved diclofenac sodium 0.1% (Voltaren ophtha; Novartis Pharma), or preserved ketorolac tromethamine 0.5% (Acular; Pharm Allergan) eyedrops 4 times daily for 4 weeks after surgery. During the 1-month follow-up, anterior chamber flare and mean foveal thickness were evaluated for objective comparison of the anti-inflammatory effect. Ocular tolerability was assessed by observer-based grading of conjunctival hyperemia and ocular discomfort, as well as obtaining subjective ratings of ocular tolerability on a visual analog scale. Distance and near visual acuity and intraocular pressure served as safety measures. All 3 formulations demonstrated equal anti-inflammatory efficacy as measured by reduction of anterior chamber flare after surgery and prevention of postoperative macular edema. Patients treated with preservative-free diclofenac eyedrops reported significantly better subjective tolerability values (P = .001), were classified as having less ocular discomfort (P < .001), and experienced earlier reduction of postoperative conjunctival hyperemia (P = .029). Anti-inflammatory efficacy was comparable for all 3 agents. However, preservative-free diclofenac 0.1% eyedrops exhibited a significantly better postoperative subjective and objective tolerability when compared with preserved eyedrops containing ketorolac or diclofenac.

Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma

To evaluate whether dexamethasone injected intracamerally at the conclusion of surgery can safely and effectively reduce postoperative inflammation and improve surgical outcomes in eyes with and without glaucoma. Retrospective chart review of 176 consecutive eyes from 146 patients receiving uncomplicated phacoemulsification (PE) (n = 118 total, 82 with glaucoma), glaucoma drainage device (GDD) (n = 35), combined PE/GDD (n = 11) and combined PE/endoscopic cyclophotocoagulation (n = 12). Ninety-one eyes from 76 patients were injected with 0.4 mg dexamethasone intracamerally at the conclusion of surgery. All eyes received standard postoperative prednisolone and ketorolac eyedrops. Outcomes were measured for four to eight weeks by subjective complaints, visual acuity (VA), slit-lamp biomicroscopy, intraocular pressure (IOP) and postoperative complications. Dexamethasone significantly reduced the odds of having an increased anterior chamber (AC) cell score after PE (p = 0.0013). Mean AC cell score +/- SD in nonglaucomatous eyes was 1.3 +/- 0.8 in control and 0.8 +/- 0.7 with dexamethasone; scores in glaucomatous eyes were 1.3 +/- 0.7 in control and 0.9 +/- 0.8 with dexamethasone. Treated nonglaucomatous eyes had significantly fewer subjective complaints after PE (22.2% vs 64.7% in control; p = 0.0083). Dexamethasone had no significant effects on VA, corneal changes, IOP one day and one month after surgery, or long-term complications. Intracameral dexamethasone given at the end of cataract surgery significantly reduces postoperative AC cells in eyes with and without glaucoma, and improves subjective reports of recovery in nonglaucomatous eyes. There were no statistically significant risks of IOP elevation or other complications in glaucomatous eyes.

Asthma Caused by Topical Application of Ketorolac

Background: Ketorolac tromethamine 0.5% ophthalmic solution is a widely used nonsteroidal anti-inflammatory drug (NSAID) in ophthalmology. Ketorolac eye drops have not been implicated previously as -a cause of NSAID-induced asthma.Study Design: A patient with severe asthma after topical application of ketorolac is described. The current ophthalmic indications for topical application of ketorolac and reported hypersensitivity reactions with systemic use of ketorolac are reviewed.Results: A 44-year-old woman with chronic asthma, rhinosinusitis, and nasal polyps inadvertently was given ketorolac to be applied topically. After applying the first dose of ketorolac, an exacerbation of her asthma developed, necessitating hospital admission.Conclusions: Topical application of ketorolac is safe in the vast majority of ophthalmology patients. However, NSAID eye drops should not be prescribed for patients with aspirin or NSAID allergy or the combination of asthma and nasal polyps unless the patient is known to tolerate aspirin without trouble.