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Scott R Lambert, David Plager, Edward Buckley, M. Edward wilson, Michael Lynn, Infant Aphakia Treatment Study; The relationship between corticosteroid use and postoperative inflammatory adverse events in the Infant Aphakia Treatment Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6213.
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To determine if the prevalence of postoperative inflammatory adverse events in the Infant Aphakia Treatment Study (IATS) was related to the use of intraoperative corticosteroids or the frequency that topical corticosteroid were prescribed postoperatively.
The IATS is a randomized clinical trial comparing infants <7 months of age undergoing unilateral cataract surgery with intraocular lens (IOL) implantation (n=57) versus contact lens (CL) correction (n=57). The IATS protocol mandated that patients be prescribed topical prednisolone acetate 1% at least four times a day for 4 weeks following cataract surgery. Injecting corticosteroids subconjunctivally at the end of surgery was elective. Patients were monitored for adverse events at regular intervals until age 5 years. Fisher’s exact test was used to compare percentages.
Pupillary membranes developed in 2 (4%) eyes in the CL group and 16 (28%) in the IOL group (p<0.001). Topical corticosteroids were prescribed ≥6 times a day on day 1 for 30/57 (53%) eyes in the CL group and 40/57 (70%) eyes in the IOL group. The most common dosage of topical corticosteroids prescribed for both treatment groups was prednisolone acetate 6 times a day for 4 weeks. The percent of patients with pupillary membranes according to the frequency of topical corticosteroids prescribed in each treatment group was CL: <6 = 7% (2/27), ≥6 = 0% (0/30) (p=0.22); IOL: <6 = 11% (2/18), ≥6 = 36% (14/39) (p=0.064). Subconjunctival dexamethasone was administered to 48/57 (84%) eyes in each of the treatment groups (CL group, mean 2.3 ± 1.5 mg; IOL group, mean 2.5 ± 1.7 mg). The percent of patients with pupillary membranes according to the use of subconjunctival dexamethasone in each treatment group was CL: No = 11% (1/9), Yes = 2% (1/48) (p=0.29); IOL: No = 22% (2/9), Yes = 29% (14/48) (p=0.99).
The IATS recommended that infants with a unilateral cataract be left aphakic if the parents could manage contact lenses because of the high rate of adverse events associated with IOL implantation. We did not find that injecting subconjunctival corticosteroids at the end of surgery or prescribing topical corticosteroids more frequently (≥6 times/day) after surgery was associated with a reduction in the prevalence of pupillary membranes. Other factors are likely responsible for the high rate of pupillary membranes in the IOL group.
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