Systemic absortion and adverse effects of topical ocular use of ketorolac tromethamine and sodium diclofenac in New Zealand rabbits for 90 days / Absorção sistêmica e efeitos adversos do uso tópico ocular por 90 dias de cetorolaco de trometamina e diclofenacode sódio em coelhos da raça Nova Zelândia

The effect of the systemic absorption of 0.1% diclofenac sodium (DS) eyedrop was compared to that of 0.5% ketorolac tromethamine (KT) in female New Zealand white rabbits treated on both eyes three times a day for 90 days. The rabbits were divided in three groups of six animals (n= 18): KT group, DS group, and control (Co) group, in which saline (0.9% NaCl) solution was instilled. Water and food consumption were measured daily, clinical examination was performed weekly, and blood samples were collected every 30 days for laboratory examination. The plasma was analyzed for the presence of KT and DS by solid-phase extraction (SPE) associated with mass spectrometry (MS). Systemic absorption of these drugs was confirmed by SPE-MS, allowing their separation and identification in the plasma. At the end of the treatment, the animals were euthanized and necropsied, and no macroscopic or microscopic changes were found. This observation confirmed the laboratory results, which were within normal reference standards for the species. According to the results obtained, it can be concluded that treatment with eyedrops containing KT and DS for 90 days in healthy rabbits does not cause adverse systemic effects.(AU)

Comparou-se o efeito da absorção sistêmica do colírio de diclofenaco de sódio 0,1% (DS) em relação ao de cetorolaco de trometamina 0,5% (CT) em coelhas da raça Nova Zelândia, tratadas nos dois olhos, três vezes ao dia, por 90 dias. As coelhas foram separadas em três grupos de seis animais (n=18): grupo CT, grupo DS e grupo controle (Co), no qual foi instilada solução fisiológica (NaCl 0,9%). Os consumos de água e ração foram mensurados diariamente, os exames clínicos foram realizados semanalmente e o sangue foi coletado a cada 30 dias para realização de exames laboratoriais. O plasma foi analisado para detectar a presença de CT e DS por extração em fase sólida (SPE) associada à espectrometria de massas (MS). A absorção sistêmica desses fármacos foi confirmada por SPE-MS, permitindo sua separação e identificação no plasma. Ao final do tratamento, os animais foram eutanasiados e necropsiados, e não foram encontradas alterações macroscópicas ou microscópicas. Essa observação confirmou os resultados laboratoriais, que estavam dentro dos padrões de referência para a espécie. De acordo com os resultados obtidos, pode-se concluir que o tratamento com colírio contendo KT e DS, por 90 dias, em coelhos saudáveis, não causa efeitos adversos sistêmicos.(AU)

Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis / Lágrima artificial versus cetorolaco de trometamina 0,45% associado à lagrima artificial no tratamento da conjuntivite viral aguda

Purpose: To evaluate the effects of preservativefree 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose) compared with those of preservativefree artificial tears alone on the symptoms and signs of acute viral conjunctivitis. Methods: This was a randomized, doublemasked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose). The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion) and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids) were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Results: Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05). The frequency of side effects during treatment was similar between groups (p>0.05). Conclusions: Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis. .

Objetivo: Avaliar o efeito do colírio de cetorolaco de trometamina 0,45% associado à carboximetilcelulose sem conservante em comparação ao uso isolado de lágrimas artificiais sem conservantes nos sinais e sintomas da conjuntivite viral aguda. Métodos: Ensaio clínico duplo-mascarado randomizado incluindo 50 pacientes com diagnóstico de conjuntivite viral aguda, distribuídos em dois grupos (Grupo 0: lágrimas artificiais e Grupo 1: cetorolaco 0,45% + carboximetilcelulose). Os pacientes foram orientados a utilizar a medicação quatro vezes ao dia. Sinais (hiperemia conjuntival, quemose, folículos e secreção) e sintomas (desconforto ocular geral, prurido, sensação de corpo estranho, lacrimejamento, vermelhidão e inchaço de pálpebras) foram avaliados na consulta inicial, no terceiro e no sétimo dia de tratamento utilizando um questionário padronizado e biomicroscopia de segmento anterior. Resultados: Ambos os grupos apresentaram melhora dos sinais e sintomas de conjuntivite nas visitas de reavaliação. Não foi observado diferença estatística na mudança dos escores dos sinais e sintomas entre o Grupo 0 e o Grupo 1 durante as visitas do estudo (p>0.05). A frequência de efeitos colaterais durante o tratamento foi similar entre os dois grupos (p>0.05). Conclusão: O uso do cetorolaco de trometamina 0,45% não se mostrou superior ao uso isolado de lágrimas artificiais no alívio dos sinais e sintomas da conjuntivite viral. .

Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial.

Purpose: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. Design: Randomized clinical trial. Materials and Methods: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery. Results: All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 – P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops. Conclusion: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.

Controle da dor pós-operatória em odontologia com cetorolaco de trometamol / Control of postoperative pain in dentistry with ketorolac of trometamol

O controle da dor e da inflamação pós-operatória são constantes preocupações dos cirurgiões, bem como o bem-estar do paciente após o ato cirúrgico, esses fatores estão intimamente ligados ao sucesso dos procedimentos e técnicas aplicadas. O cetorolaco é um anti-inflamatório não esteroidal (AINE) não seletivo, que age indistintamente sobre as cicloxigenases 1 e 2 e está indicado no tratamento da dor pós-operatória ou processos dolorosos de intensidade moderada a grave. Esta revisão de literatura se propôs a elucidar os efeitos analgésicos e anti-inflamatórios do cetorolaco de trometamol aplicado tanto de forma preventiva quanto pre-emptiva no tratamento da dor, bem como suas reações adversas, apresentando vantagens e desvantagens deste fármaco. Diante da revisão de literatura abordada, os autores concluíram que: a analgesia pre-emptiva deve ser feita sempre que possível; o cetorolaco de trometamol apresenta maior eficácia analgésica que os opióides, porém, deve ser usado em curto prazo, pelo risco de desenvolver doenças gastrointestinais, além do cuidado da sua indicação que segue as recomendações comuns a todos os AINES empregados em odontologia.

The pain control and postoperatory inflammation are constant concerns of surgeons, as well as the welfare of the patient after surgery, these factors are closely linked to the success of the procedures and techniques. Ketorolac is a non steroid anti-inflammatory drug (NSAID) non-selective, which acts indiscriminately on cyclooxygenase 1 and 2 and is indicated for the treatment of postoperative pain or painful processes of moderate to severe intensity. This literature review aimed to elucidate the analgesic and anti- inflammatory ketorolac trometamol applied as a preventive and preemptive treatment of pain and its adverse reactions, presenting advantages and disadvantages of this drug. Given the literature review addressed, the authors concluded that: preemptive analgesia should be performed whenever possible; ketorolac trometamol shows greater efficacy than opioids, however, should be used in short term, at risk of developing gastrointestinal diseases, beyond the care of his statement following the recommendations common to all NSAIDs used in dentistry.

Topical cyclosporine 0.5 per cent and preservative-free ketorolac tromethamine 0.5 per cent in vernal keratoconjunctivitis.

A prospective, randomized cross-over study was conducted in patients with vernal keratoconjunctivitis, successfully treated with cyclosporine, to evaluate the efficacy of cyclosporine 0.5 per cent compared with preservative-free ketorolac tromethamine 0.5 per cent. Patients received topical cyclosporine in both eyes along with an assessment of the severity of their conjunctivitis. In cyclosporine-treated patients, medication was discontinued 1 week before evaluation, then the medication was started for I month, and washed out 1 week before the other drug was started. Symptoms of itching, foreign body sensation, tearing, photophobia, discharge, burning, conjunctival injection, chemosis, giant papilla, keratopathy and intraocular pressure were evaluated weekly. There was a statistically significant decrease in all symptoms of cyclosporine-treated eyes at day 7, 14 and 30 and all signs at day 21 and 30. In ketorolac-treated eyes, there was a significant difference in itching, foreign body sensation, photophobia, tearing, mucous discharge, all symptoms, chemosis, giant papillae and conjunctival injection at day 7, and overall symptoms at day 14. Compared to cyclosporine-treated eyes at day 7, kotorolac-treated eyes had significantly fewer symptoms. Topical cyclosporine 0.5 per cent reduces symptoms and signs slower than preservative-free ketorolac tromethamine 0.5 per cent.

Comparison of topical prednisolone acetate, ketorolac tromethamine and fluorometholone acetate in reducing inflammation after phacoemulsification.

AIMS: To compare the efficacy and ocular adverse effects of topical prednisolone acetate, ketorolac tromethamine, and fluorometholone acetate in reducing inflammation after phacoemulsification. METHOD: One hundred and twenty eyes were enrolled in a prospective, investigator-masked, randomized controlled trial. Each drug was prescribed 4 times a day for 28 days. The following data were recorded weekly: visual acuity, intraocular pressure, slit lamp biomicroscopy, grading of cells and flare in the anterior chamber, and ocular symptoms. RESULTS: The number of eyes with a minimal amount of cells in the anterior chamber in the ketorolac group was less than the prednisolone group on day 7 (11:20, p = 0.008) and day 14 (23:31, p = 0.015), and than fluorometholone group on day 7 (11:21, p = 0.011). Intraocular pressure in the prednisolone group was higher than the ketorolac group on day 21 (14.6:12.2 mmHg, p = 0.016). One eye in the prednisolone group had intraocular pressure of 32 mmHg. Burning sensation was reported frequently in the ketorolac group. CONCLUSION: All 3 drugs were effective in reducing post-operative inflammation. The efficacy of prednisolone acetate and fluorometholone acetate was comparable. Ketorolac tromethamine showed less efficacy than corticosteroids, however, it did not induce ocular hypertension.

Topical ketorolac tromethamine in the reduction of adverse effects of laser in situ keratomileusist.

PURPOSE : To evaluate whether topical ketorolac tromethamine can reduce the adverse effect of laser in situ keratomileusis (LASIK). DESIGN: A prospective randomized controlled clinical study. PARTICIPANTS: Nineteen patients who underwent bilateral simultaneous LASIK performed at Siriraj Hospital. INTERVENTION: Patients received two drops of ketorolac tromethamine in one eye immediately after surgery. MAIN OUTCOME MEASURES: Symptoms of tearing, photophobia, foreign body sensation and pain were evaluated at 30 minutes, 6 hours and 24 hours. RESULTS: There was no statistically significant difference in symptoms at 30 minutes. At 6 and 24 hours, ketorolac-treated eyes had significantly fewer symptoms compared to non-treated eyes. CONCLUSIONS: Ketorolac tromethamine reduces some unfavorable symptoms within the first 24 hours after LASIK.