JCRS highlights chosen by Professor Thomas Kohnen, European Editor, JCRS

KETOROLAC AND PHENYLEPHRINE BETTER TOGETHER A novel drug that combines phenylephrine and ketorolac (OMS302) for intracameral administration proved safe and efficacious in maintaining mydriasis and reducing postoperative ocular pain in a multicentre randomised clinical trial. Moreover, the combination proved superior to either agent alone in maintaining an intraoperative pupil diameter of 6.0mm or larger. The study included 223 patients from 23 centres who were randomised to receive vehicle, phenylephrine, ketorolac, or the study drug containing phenylephrine and ketorolac administered intracamerally during cataract surgery. Significantly fewer patients treated with the study drug (6.1%) had an intraoperative pupil diameter smaller than 6.0mm compared with those treated with the vehicle (47.2%; P<.0001), ketorolac (34.6%; P=.0004), or phenylephrine (22.4%; P=.0216). ED Donnenfeld et al, JCRS, "Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery"; Volume 43, Issue 5, 597–605. LONG-TERM ASTIGMATIC CHANGES Corneal astigmatism continues to change towards against-the-rule astigmatism over a period of decades, a new study reveals. Researchers measured corneal astigmatism prior to phacoemulsification cataract surgery in 74 eyes, and in another 68 that did not undergo surgery. This change was similar in eyes that did not have surgery. They were able to take follow-up measurements using power vector analysis 10 and 20 years after baseline measurements. The mean vertical/horizontal change in corneal astigmatism (J0) between baseline and 20 years was -0.64D in the surgery group and -0.49D in the no-surgery group. 
K Hayashi et al, JCRS, "Changes in corneal astigmatism during 20 years after cataract surgery"; Volume 43, Issue 5, 615–621. ASYMMETRIC MULTIFOCAL IOLS SHOW PROMISE Rotationally asymmetric multifocal intraocular lenses (IOLs) appear to offer a promising alternative for the treatment of presbyopia. These IOLs have two distinct zones – that is, a distance zone and a near zone. In contrast, traditional rotationally symmetrical multifocal IOLs consist of concentric rings to provide multifocality. Investigators enrolled 50 refractive lens exchange patients in a prospective study of the SBL-3 IOL and evaluated vision at the three- and 12-month marks. The asymmetric multifocal IOL provided excellent unaided vision with no significant difference in near, intermediate, and distance vision three months and 12 months postoperatively. A quality-of-vision survey indicated a significant improvement in subjective outcomes at the second postoperative assessment, during which patients reported significantly better quality of vision scores and less blurred vision. RN McNeely et al, JCRS, "Visual outcomes and patient satisfaction 3 and 12 months after implantation of a refractive rotationally asymmetric multifocal intraocular lens"; Volume 43, Issue 5, 633–638.