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Nathalie Butel, Emmanuelle Champion, Valerie Touitou, Christine Fardeau, Bahram Bodaghi, Phuc Le Hoang; Cataract and uveitis: Comparison of two different anti inflammatory regimens for the prevention of post-operative complications. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2051.
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To compare the efficacy of the classical anti inflammatory regimen and a simplified protocol in patients with uveitis, undergoing cataract surgery.
Retrospective monocentric, nonrandomized, open study, conducted in 2012 and including patients followed for uveitis, requiring cataract surgery. Patients received either a complete regimen (pre and post operative oral corticosteroids, intraoperative iv methylprednisolone and subconjunctival dexamethasone) (group A), or a simplified regimen including iv and subconjonctival corticosteroids (group B). Each regimen was attributed based on the severity of posterior synechiae and the risk of macular edema. Anterior chamber inflammation was analyzed based on SUN criteria and laser flare photometry. Central macular thickness was evaluated by OCT preoperatively and postoperatively (45 days + / -10).
The study included 34 eyes of 29 patients with a mean age of 53.9 years. After a median follow up of 6 months (3-9 months), VA improved significantly in both groups : 0.7 to 0.26 logmar in group A, and 0.44 to 0.15 logmar in group B. Flare values went from 56.8 ph/ms to 50.36 ph/ms (group A) and from 21.4 ph/ms to 12.38 ph/ms in group B. Central macular thickness increased from 220.9 microns to 242.2 microns (group A) and from 224 microns to 242.4 microns (group B). Postoperative complications were predominantly observed in group A : 3 early inflammatory relapses, 2 macular edema, 1 epimacular membrane and a retinal detachment with vitreoretinal traction in a case of toxocariasis. In group B, we only deplore 1 early anterior uveitis. Inflammatory complications were related to the history of uveitis, its etiology, the preoperative inflammatory state and a past medical history of macular edema. They were not related to the protocol.
Even though uveitis was less severe in group A, the results are encouraging. Therefore, a simplified prophylactic anti inflammatory regimen may be considered in patients with prolonged quiescence and without macular edema.
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