Is Toradol (ketorolac) contraindicated after cataract surgery?

Toradol (Ketorolac) After Cataract Surgery: Safety and Efficacy

Toradol (ketorolac) is not contraindicated after cataract surgery and is actually recommended as part of post-surgical management to reduce inflammation and pain. 1, 2

Benefits of Ketorolac After Cataract Surgery

• Ketorolac effectively reduces postoperative inflammation, with significantly more patients achieving complete resolution of anterior chamber cell and flare compared to placebo (52.5% vs 26.5%) 2
• Provides superior pain control, with 72.4% of ketorolac patients reporting no pain on postoperative day 1 compared to 39.7% of vehicle patients 2
• Helps maintain pupil dilation during surgery when administered preoperatively, reducing intraoperative miosis compared to steroid-only treatment 3
• Contributes to better visual outcomes, with more patients achieving +3-line or greater improvement in best-corrected visual acuity (60.5% vs 44.0% with vehicle) 2
• Reduces macular thickness changes and volume after surgery, particularly beneficial for patients with diabetes mellitus 3

Current Recommendations for Post-Cataract Surgery Management

• Preservative-free NSAIDs like ketorolac are specifically recommended for use within the first post-surgical month to manage dry eye disease and inflammation 1
• The combination of topical NSAIDs with steroids provides more effective control of postoperative inflammation than steroids alone 3
• Preservative-free formulations (such as ketorolac 0.45%) are preferred, especially in high-risk patients, to minimize ocular surface irritation 1
• Twice-daily dosing of preservative-free ketorolac 0.45% has demonstrated good efficacy and tolerability in clinical trials 2

Safety Profile

• Ketorolac 0.5% has shown a safety profile comparable to vehicle in terms of adverse events, changes in visual acuity, intraocular pressure, and biomicroscopic variables 4
• In comparative studies, ketorolac 0.5% demonstrated similar efficacy to prednisolone acetate 1% for controlling postoperative inflammation and pain, with no significant changes in intraocular pressure 5
• Overall adverse events are actually less prevalent with ketorolac than with vehicle (35.2% vs 48.5%) 2
• The most common side effect is mild burning or stinging upon instillation, reported by only 1.5% of patients 2

Practical Considerations

• For optimal results, consider initiating ketorolac treatment before surgery and continuing postoperatively 3
• The recommended regimen is twice-daily administration for approximately 2 weeks following surgery 2
• When using multiple topical medications, space applications by at least 5 minutes to avoid washout effects
• For patients with diabetes mellitus, ketorolac is particularly beneficial in preventing macular thickness changes 3

Potential Pitfalls and Caveats

• While preservative-free formulations are preferred, they may be more expensive than preserved versions
• Patients with known hypersensitivity to NSAIDs should avoid ketorolac
• Although rare, there is potential for delayed corneal epithelial healing with prolonged use of topical NSAIDs
• Consider the full medication regimen to avoid drug interactions or cumulative toxicity from multiple eye drops

In conclusion, not only is Toradol (ketorolac) not contraindicated after cataract surgery, but it is an effective and recommended component of post-surgical care to reduce inflammation and pain while potentially improving visual outcomes.