General Information
Efexlria (phenylephrine and ketorolac injection) is a combination of an anti-inflammatory agent and a mydriatic agent (causes pupil dilation, called mydriasis).
Efexlria is specifically indicated for use during cataract surgery or intraocular lens replacement for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.
Efexlria is supplied as a solution for intraocular administration. For administration 4 mL of Efexlria is diluted in 500 mL of ophthalmic irrigation solution. Irrigation solution is to be used as needed for the surgical procedure.
Clinical Results
FDA Approval
The FDA approval of Efexlria was based on three phase III randomized, multicenter, double-masked, placebo-controlled clinical trials in 808 adult subjects undergoing cataract surgery or intraocular lens replacement. Subjects were randomized to either Efexlria or placebo. Subjects were treated with preoperative topical mydriatic and anesthetic agents. Pupil diameter was measured throughout the surgical procedure. Postoperative pain was evaluated by self-administered 0-100 mm visual analog scales (VAS). Mydriasis was maintained in the Efexlria-treated groups while the placebo-treated groups experienced progressive constriction. At the end of cortical clean-up, 23% of placebo-treated subjects and 4% of Efexlria-treated subjects had a pupil diameter less than 6 mm (p < 0.01). Pain during the initial 10-12 hours postoperatively was statistically significantly less in the Efexlria-treated groups than in the placebo-treated groups. During the 10-12 hours postoperatively, 26% of Efexlria-treated subjects reported no pain (VAS = 0 at all timepoints) while 17% of placebo-treated subjects reported no pain (p < 0.01).
Side Effects
Adverse effects associated with the use of Efexlria may include, but are not limited to, the following:
eye irritation
posterior capsule opacification
increased intraocular pressure
anterior chamber inflammation
Mechanism of Action
Efexlria contains the active ingredienta phenylephrine and ketorolac. Phenylephrine is an a1-adrenergic receptor agonist and, in the eye, acts as a mydriatic agent by contracting the radial muscle of the iris. Ketorolac is a nonsteroidal anti-inflammatory that inhibits both cyclooxygenase enzymes (COX-1 and COX-2), resulting in a decrease in tissue concentrations of prostaglandins to reduce pain due to surgical trauma. Ketorolac, by inhibiting prostaglandin synthesis secondary to ocular surgical insult or direct mechanical stimulation of the iris, also prevents surgically induced miosis.