KETOROLAC, PREDNISOLONE, AND DEXAMETHASONE FOR POSTOPERATIVE INFLAMMATION

This 6-week, partially masked, three-arm, multicenter study was conduc ted to evaluate the postoperative anti-inflammatory efficacy of ketoro lac, a cyclooxygenase inhibitor. The study setting was the clinical pr actice of six ophthalmic surgeons. The study enrolled 157 candidates f or routine extracapsular cataract extraction or phacoemulsification an d posterior-chamber intraocular lens implantation. Patients who receiv ed any glucocorticoid or cyclooxygenase inhibitor within 1 week of sur gery were excluded. All patients were treated with solutions of 0.5% k etorolac, 1% prednisolone acetate, or 0.1% dexamethasone instilled int o the operative eye three times daily from 1 day before surgery to 4 w eeks after surgery. Efficacy variables included the signs of anterior- segment inflammation, primarily cells and flare in the anterior chambe r, as observed by slit-lamp biomicroscopy; fluorescein leakage across the blood-aqueous barrier, as measured by fluorophotometry; and the ra ting of efficacy by the investigator. No significant differences were seen between ketorolac and either glucocorticoid in cells and flare. N o significant differences were found in other signs of inflammation, e xcept conjunctival hyperemia and Descemet's folds at week 2. Ketorolac showed significantly greater efficacy than the glucocorticoids agains t blood-aqueous barrier breakdown at day 5 and week 2, as demonstrated by the difference in fluorescein concentration between the operated a nd nonoperated eyes. Investigators did not detect any significant diff erence in rating for overall effectiveness and acceptability. These fi ndings support the use of ketorolac as an alternative to glucocorticoi ds for the treatment of postoperative inflammation.