Abstract
Purpose: :
The first objective was to compare the efficacy of a topical steroid (dexamethason 0,1% eyedrops) with a subconjunctival injection of steroids (bethamethasone; Celestone Chronodose), in reducing intraocular inflammation and development of cystoid macular edema (CME) after cataract surgery. The second objective was to evaluate the rationale for physostigmine (eserine) following cataract surgery.
Methods: :
Three hundred patients (300 eyes) diagnosed with age-related cataract were prospectively randomised in order to receive dexamethason eyedrops (n=150) three times a day for three weeks or a single subconjunctival injection of bethamethasone (n=150) after phacoemulsification; either with or without administration of physostigmine. Preoperatively and postoperatively after 4 weeks, inflammation parameters, presence or absence of CME, intraocular pressure (IOP), best corrected visual acuity (BCVA) and development of peripheral anterior synechiae were evaluated. Moreover postoperatively at day 1 the IOP and pain level were documented. Inflammation parameters were quantified using the Kowa Laser Flare Meter and Optical Coherence Tomography was performed to evaluate the status of retina and the development of CME.
Results: :
All groups showed no significant difference in development of CME, pain level, BCVA, extra outpatient clinic visits, lens luxation and development of peripheral anterior synechiae. Not any of the groups had an important IOP raise or serious adverse events. The inflammation parameters showed a significant higher median laser flare value after 4 weeks postoperatively in the group with a single subconjunctival celestone chronodose injection. There’s no significant difference in the development of intraocular inflammation or the amount of laser flare peaks after 4 weeks postoperatively between all groups.
Conclusions: :
Subconjunctival bethamethasone injection appeared to be as effective as dexamethasone 0,1% eyedrops in preventing intraocular inflammation and development of CME after phacoemulsification. The use of physostigmine in preventing lens luxation and peripheral anterior synechiae after cataract surgery has lost its rationale.
Clinical Trial: :
www.trialregister.nl/trialreg/index.asp NTR779
Keywords: cataract • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • corticosteroids