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Andres Piscoya, Steve Gerber; Minimal post-operative anti-inflammatory drops following YAG laser capsulotomy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):676.
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It is common practice for ophthalmologists to have patients use post-operative anti-inflammatory drops, either steroid or non-steroidal, after YAG laser capsulotomy (YLC). However, there are no studies that evaluate the necessity of these medications. We performed a prospective, observational clinical study that investigates whether patients require outpatient use of anti-inflammatory drops following YLC.
Over a six-month period, 34 consecutive patients requiring YLC received a single dose of prednisolone acetate at the time of the laser with no other post-operative anti-inflammatory medications. All patients had their pupils dilated prior to the laser. In addition, all patients received a single drop of Brimonidine .2% before and after the procedure for intraocular pressure (IOP) control. Patients were examined 1-2 weeks postoperatively. Post-operative examination consisted of visual acuity as well as slit lamp exam for anterior chamber inflammation, IOP and retinal examination for the presence of cystoid macular edema (CME). Anterior chamber inflammation was graded at the slit lamp by the same observer in all cases. IOP was measured using applanation tonometry. If vision was 20/30 or below, the macula was evaluated for presence of CME using Optical Coherence Tomography (SD-OCT). Patients were excluded from the study if there was preoperative presence of diabetic edema or CME since these patients receive post YAG-laser anti-inflammatory medications.
A total of 34 patients completed the study. One patient was excluded due to pre-existing macular edema. The average total energy used was 42.35±17.67mJ. There was no significant difference between the pre-operative and post-operative mean IOP of 14.38±3.32mmHg versus 14.97±3.96mmHg (p=0.51). LogMAR scale showed a significant improvement in visual acuity between the pre and post-operative mean values of 0.29±0.30 versus 0.07±0.08 (p< .001). No patients with 20/30 or worse vision post-operatively had evidence of CME on OCT testing. There was no anterior chamber inflammation noted at the post-operative visit.
Using only a single post-operative dose of prednisolone acetate with no additional outpatient anti-inflammatory medications demonstrated no harmful effect in terms of IOP, anterior chamber inflammation or CME following YLC. Patients without pre-existing macular edema do not require outpatient anti-inflammatory medications after YLC.
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