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Zeeshan Haq, Michael Zhang, Mark Benjamin, Kamran Riaz; Outcomes after Intravitreal Antibiotic-Steroid Injection during Femtosecond-laser Assisted Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4794.
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Predictors of postoperative complications requiring pharmacotherapy after femtosecond-laser assisted cataract surgery (FLACS) with an intravitreal antibiotic-steroid (IVAS) injection have not been studied. Herein, we report the results of a regression analysis from a retrospective case series to test the hypothesis that suspected risk factors may be associated with the unplanned use of topical medications in this context.
This study includes 164 eyes (median age = 73 years; 64.6% female) that underwent FLACS with an IVAS injection between 09/2014 and 06/2016. An experienced cataract surgeon (M.B. or K.R.) performed each procedure and patients were followed for a minimum of 4 weeks. An intraocular pressure > 30 mm hg on postoperative day one and breakthrough inflammation or cystoid macular edema (CME) at any point during the follow-up period indicated initiation of a short course of topical hypotensive and anti-inflammatory medication, respectively. Univariate logistic regression was used to identify potential predictors of the unplanned use of topical pharmacotherapy.
The unplanned use of topical hypotensive medication occurred in 24 (14.6%) eyes and was associated with systemic hypertension (OR = 4.59, 95% CI = 1.49 to 14.11, p = 0.008); however, it was not associated with a diagnosis of glaucoma or ocular hypertension status (OR = 1.48, 95% CI = 0.84 to 2.61, p = 0.180). The unplanned use of topical anti-inflammatory medication occurred in 37 (22.6%) eyes and was associated with diabetes mellitus (OR = 3.91, 95% CI = 1.51 to 10.13, p = 0.005) and cataract grade (OR = 2.74, 95% CI = 1.43 to 5.23, p = 0.002). Of 134 eyes that underwent final refractive testing, a best corrected visual acuity of 20/25 or better was achieved in 113 eyes (84.3%). At the conclusion of the follow-up period, CME (confirmed by optical coherence tomography) and clinical endophthalmitis were diagnosed in 10 (6.1%) and 0 (0.0%) eyes, respectively.
In patients undergoing FLACS, a combination approach that includes both intravitreal and topical prophylactic therapy may be appropriate in patients with hypertension, diabetes mellitus, and/or high cataract grade. Overall, the use of an IVAS injection obviates the need for topical medication in most patients; however, future studies aimed at evaluating the efficacy of this novel technique in the prevention of CME are needed.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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