![]() preoperative mydriasis less than 6 mm prior to the study,.diagnosis of diabetes mellitus with/without diabetic retinopathy and/or macular edema,.use of topical or systemic NSAIDs within 14 days prior to inclusion in the study,.use of topical or systemic steroids within 30 days prior to inclusion in the study,.knowledge or suspicion of allergy or hypersensitivity to the preservatives, steroids, topical NSAIDs, or any other component of the study medication,.history of any neuro-ophthalmologic pathologies,.history of ipsilateral ocular surgery and/or trauma,.alterations of the ocular surface (e.g., dry eye),.treatment of eye infection within 30 days prior to inclusion in the study,.history of ocular inflammatory or infectious eye disease,. ![]() had continuous, circular capsulorhexis of 5 to 6 mm diameter.had history of unremarkable phacoemulsification with capsular-bag IOL implantation to the contralateral eye, and.had normal funduscopic exam (if retina view was possible),.were scheduled for cataract surgery by phacoemulsification and capsular bag IOL implantation,.had been diagnosed with mature cataract according to the Lens Opacities Classification System (LOCS III), with classification NO and/or NC 2–3,.We conducted a prospective, randomized, doublemasked comparative study involving 47 eyes of 44 Filipino patients diagnosed with mature cataract who underwent cataract surgery by phacoemulsification and capsular bag IOL implantation in a tertiary hospital from March to August 2010. Specifically, this study determined the horizontal and vertical pupillary diameters in 4 different stages of phacoemulsification compared pupillary diameter measurements among the ketorolac, nepafenac, and placebo groups and determined the total loss and percent total loss of mydriasis. This study compared the effect of 2 newer topical NSAIDs widely available in the Philippines-ketorolac 0.5% and nepafenac 0.1%. Ketorolac provided a more stable mydriatic effect throughout the surgical procedure. Solomon5 compared the effects of topical 0.5% ketorolac tromethamine ophthalmic solution with topical 0.03% flurbiprofen sodium on the inhibition of surgically induced miosis during phacoemulsification. Coste6 showed that nepafenac given 3 times a day 1 day before cataract surgery was superior to tobramycindexamethasone eye drops in maintaining intraoperative mydriasis measured at 4 different stages of the surgery. Mydriatics and antiprostaglandins are routinely applied preoperatively to facilitate cataract extraction and prevent intraoperative miosis.4 Previous studies have demonstrated the effectiveness of various topical nonsteroidal antiinflammatory drugs (NSAIDs) (indomethacin, flurbriprofen, suprofen) in preventing miosis during cataract surgery compared to placebo.5 Newer topical NSAIDs also showed similar favorable effects. During cataract surgery, maintenance of mydriasis is necessary to facilitate proper incision of the anterior capsule, safe removal of the cataract, and implantation of intraocular lens. Evidence has shown that intraocular manipulation can trigger the inflammatory cascade, releasing cyclooxygenase (COX) and prostaglandins within the eye causing miosis. Her vital signs were normal, and an electrocardiogram was unremarkable.PHACOEMULSIFICATION with intraocular-lens (IOL) implantation is the current surgical treatment of choice for cataract extraction.1-3 To prevent complications during surgery, there should be adequate pupillary dilation for better visualization of the posterior chamber. Eye movements, reflexes, and other neurological examination findings were normal. On examination, the right pupil was dilated (mydriasis) (fig 1), direct and consensual light reflexes were abolished, and there was loss of accommodation-all suggesting dysfunction of the ocular parasympathetic pathway. Corrected visual acuity in the right eye was 0.8 and in the left eye was 1.0. ![]() ![]() ![]() She had no headache, eye pain, or double vision.
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