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Jesper Hoeiberg Erichsen, Lars Morten Holm, Mads Forslund Jacobsen, Julie Lyng Forman, Line Kessel; Prednisolone and ketorolac versus ketorolac alone or dropless prophylaxis of macular thickening in cataract surgery. Invest. Ophthalmol. Vis. Sci. 2021;62(8):565.
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Choice of anti-inflammatory prophylaxis parallel to cataract surgery is contested. We performed a randomized controlled trial to determine if combination of prednisolone- and non-steroidal anti-inflammatory drug (NSAID) eye drops was superior in preventing increased central macular thickness (CMT) following uncomplicated cataract surgery compared with NSAID monotherapy and dropless surgery, and to test if preoperative initiation of eye drop treatment was superior to initiation on the day of surgery.
Low-risk participants scheduled for cataract removal were randomized to 1 of 5 anti-inflammatory prophylactic regimens; combination of prednisolone- (Pred Forte 1%) and ketorolac (Acular 0.5%) eye drops with or without preoperative initiation (Pred+NSAID-Pre (control) and Pred+NSAID-Post), ketorolac monotherapy with or without preoperative initiation (NSAID-Pre and NSAID-Post) or subtenon depot of dexamethasone (Dropless). Eye drops were administered 3 times per day until 3 weeks after surgery. Primary outcome was CMT 3 months after surgery. Secondary outcomes were intraocular pressure (IOP), visual acuity (VA) and subjective tolerance of treatment. Outcomes were measured at baseline, 3 weeks and 3 months postoperatively.
We included 470 participants, mean age 72.2 (SD 7.0) years, 290 (62%) females – 94 participants in each group. Three months after surgery, CMT was (mean [95%CI]) 250.7 [247.6 ; 253.7] with Pred+NSAID-Pre, 250.7 [247.8 ; 253.7] with Pred+NSAID-Post, 251.3 [248.2 ; 254.4] with NSAID-Pre, 249.2 [246.2 ; 252.3] with NSAID-Post and 255.2 [252.0 ; 258.3] with Dropless. There were no significant differences compared with control and no differences between Pre- and Post-groups, but 56.6% in Dropless group needed additional treatment. NSAID monotherapy- and Dropless groups had significantly lower IOP until 3 weeks after surgery compared with control. There were no significant differences in VA or subjective tolerance at any postoperative time.
Combination of prednisolone and NSAID eye drops was not superior to NSAID monotherapy in preventing central macular thickening, but subtenon depot of dexamethasone was inefficient as a dropless approach. Initiating prophylactic treatment 3 days before surgery was not superior to initiation on the day of surgery. Adding prednisolone to NSAID eye drops resulted in higher IOP during treatment.
This is a 2021 ARVO Annual Meeting abstract.
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