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Jesper Hoeiberg Erichsen, Lars Holm, Line Kessel; Effect of anti-inflammatory regimen on early postoperative inflammation following cataract surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):813.
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© ARVO (1962-2015); The Authors (2016-present)
Successful outcome after cataract surgery depends among other factors on controlling the inflammatory response. We conducted a randomized controlled trial aimed at evaluating the effect of different types of anti-inflammatory prophylaxis. Traditionally, steroids are used which have broad anti-inflammatory effects but bioavailability and potency vary. Non-steroid anti-inflammatory drugs (NSAIDs) are more specific and meta-analyses have shown superiority in controlling postoperative inflammation.
Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 anti-inflammatory prophylactic regimens; combination of topical prednisolone and ketorolac (NSAID) (groups a1 and a2) vs. ketorolac alone (groups b1 and b2) vs. drop-less surgery (subtenon depot of dexamethasone) (group c). In groups 1 treatment was initiated 3 days before surgery (groups a1 and b1) and in groups 2 it was started on the day of surgery (groups a2 and b2). Anterior chamber flare was measured on undilated pupils using a flare photometer (KOWA FM-600, KOWA Company, Japan) at baseline and 3 days after surgery.
A total of 470 participants, mean age 72.2 (SD 7.01) years, 290 (62%) females and 180 (38%) males, were randomized; 94 participants in each group. Flare increased significantly from baseline in all groups (mean increase, 95%CI), 67.0% [47.4% ; 89.2%], 80.3% [59.4% ; 103.8%], 106.3% [81.9% ; 133.9%], 96.6% [73.7% ; 122.4%], 203.0% [166.4% ; 244.5%] in groups a1, a2, b1, b2 and c respectively. The drop-less group increased significantly more compared to all other groups, p < 0.001, with no significant differences between rest of the groups. Additional anti-inflammatory treatment was administered in <4% of participants except for the drop-less group (36.1%). Visual acuity (VA) improved -0.199 [-0.218 ; -0.179] logMAR with no significant differences between groups.
We found no significant differences in anterior chamber flare between patients randomized to NSAID or NSAID + prednisolone but subtenon depot of dexamethasone was less efficient in controlling inflammation and 1/3 of patients required additional topical therapy to control inflammation.
This is a 2020 ARVO Annual Meeting abstract.
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