Abstract
Purpose :
To compare the safety and efficacy of topical prednisolone, transzonular triamcinolone-moxifloxacin, and intra-canalicular dexamethasone ophthalmic insert for the prevention of post-operative inflammation after cataract surgery.
Methods :
Retrospective consecutive case series. Patients undergoing phacoemulsification cataract surgery received topical prednisolone acetate (Jan 2018-Dec 2019), transzonular triamcinolone-moxifloxacin (Tri-Moxi, ImprimisRx)(Nov 2016-Jan 2018), and intracanalicular dexamethasone (Dextenza, Ocular Therapeutix)(Dec 2019-Nov 2020). Patients with a history of glaucoma suspect, glaucoma, intraocular pressure (IOP) elevation, or uveitis were excluded. Primary endpoints were proportion of eyes with breakthrough inflammation requiring escalation of anti-inflammatory therapy and proportion of eyes with IOP increase ≥10mmHg at 4-8 weeks follow-up. Secondary endpoints included post-operative visual acuity (VA) and intra-operative complications. The Kruskal-Wallis test was used to compare between groups of data. Data were reported as mean±standard error. Statistical significance was assumed at p<0.05.
Results :
Of 161 study eyes, 59 eyes from 35 patients received drops, 54 eyes from 33 patients received transzonular injection, and 48 eyes from 30 patients received the intracanalicular insert. Three (5.1%), 9 (16.7%), and 4 (8.3%) eyes from each group, respectively, developed symptomatic rebound inflammation (p=0.11). IOP increase ≥10mmHg from baseline was measured in 0 (0.0%), 1 (1.9%) and 1 (2.1%) eye, respectively (p=0.55). Mean baseline VA in logMAR was 0.33±0.04, 0.33±0.04, and 0.27±0.03, respectively (p=0.34). Mean logMAR VA at the 4-8 week post-operative visit was 0.13±0.03, 0.18±0.04, and 0.10±0.02, respectively (p=0.17). Two eyes in the drops group did not receive drops as prescribed due to poor compliance. One eye in the injection group was not successfully injected with drug and was placed on topical drops. Three eyes in the dexamethasone insert group that developed rebound inflammation did so due to extrusion of the inserts.
Conclusions :
“Dropless cataract surgery” may yield similar rates of breakthrough inflammation and IOP elevation as topical drops. Whereas drops are susceptible to non-compliance, transzonular and intracanalicular corticosteroids rely on delivery and sustained presence of the dispensed agent.
This is a 2021 ARVO Annual Meeting abstract.