Comparison of the frequency of use of a pupil expansion device with and without an intracameral phenylephrine and ketorolac injection 1%/0.3% at the time of routine cataract surgery

PURPOSE: The objective of this study is to evaluate whether a phenylephrine and ketorolac injection 1%/0.3% (phenyl/keto injection) (Omidria(®)) prior to capsulotomy decreases the need for the Malyugin Ring(®) to manage small pupils. SETTING: Bucci Laser Vision Institute, Wilkes-Barre, PA, USA. DESIGN: Retrospective analysis of cataract surgeries performed by a single surgeon at a single center. METHODS: A historical control group of 1,004 consecutive cases (December 2013 to February 2015) did not receive a phenyl/keto intracameral injection prior to capsulotomy and were compared with 915 consecutive cases in the treatment group (June 2015 to April 2016) for the rate of use of the Malyugin Ring. Epinephrine injections were selectively used in the control group as per surgeon judgment. Use of the femtosecond laser was recorded for both groups. The incidence of alpha-1 blocker patients and the use of the femtosecond laser were recorded for both groups. RESULTS: In the 1,004 cases performed in the historical control group without a phenyl/keto injection, the surgeon chose to use the Malyugin Ring 79 times (7.87%). In the 915 cases performed in the treatment group, the surgeon chose to use the Malyugin Ring 27 times (2.95%). The surgeon selectively used intracameral injections of epinephrine in the control group 64 times (6.47%). There was no significant difference in the use of the femtosecond laser in the control group (15.04%) versus the treatment group (16.28%); however, 4 (2.65%) femtosecond patients in the control group required a Malyugin Ring, while zero patients needed the ring in the femtosecond treatment group. The incidence of Malyugin Ring use in alpha-1 blocker patients was 12/49 (24.49%) in the control group and 6/49 (12.74%) in the treatment group (P=0.05). CONCLUSION: The frequency of use of the Malyugin Ring was significantly reduced (P<0.001) from 7.87% to 2.95% with this treatment. These results strongly suggest that the antimiotic/anti-inflammatory effects of this phenyl/keto injection reduced facility costs, surgical time, and other complexities related to the use of the Malyugin Ring during phacoemulsification.