Abstract
Purpose :
Traditional extended drop regimens after vitreoretinal surgery can be burdensome, and whether abbreviated ointment-based regimens are equally effective has not been addressed in literature. We performed a retrospective consecutive case series from a single surgeon before and after a regimen switch to assess rates of cystoid macular edema (CME) and endophthalmitis between patients who received an extended drop regimen versus short term ointment therapy for routine vitreoretinal cases.
Methods :
A retrospective chart review of 245 eyes that underwent routine vitreoretinal surgery from a single surgeon at multiple sites was conducted with IRB approval. Data collected included patient age, diagnosis, lens status, type of surgery, use of subconjunctival medications, use of sub-tenon kenalog (STK), final ocular fill, and postoperative regimen (4 weeks of drops versus one week of ointment). Routine surgeries were defined as pars plana vitrectomy for vitreous opacities, non-diabetic vitreous hemorrhages, epiretinal membranes, full-thickness macular holes, and vitreomacular traction. Exclusion criteria included follow-up of less than two weeks, surgery for retinal detachment, history of significant diabetic retinopathy/edema, significant unrelated retinal disease, or uveitis. Statistical analysis was done with SPSS (IBM, 27e). Binary logistic regression was conducted using a p-value threshold of 0.05 for confounding variables, and odds ratios were calculated.
Results :
Of 245 eyes, 111 received antibiotic/steroid ointment for one week and 131 received an extended steroid drop taper with one week of antibiotic drops. 1/111 in the ointment developed endophthalmitis, and no patients in the drop group. 35/111 eyes in the ointment group versus 48/131 eyes in the drops group developed CME requiring treatment, and statistically significant risk factors across groups included type of surgery, use of STK, and age. No statistically significant differences were found in development of CME between the two therapy groups (p-value: 0.94, OR CI: 0.54-1.78).
Conclusions :
We found no difference in the development of CME between the two postoperative regimen cohorts. Only one case of endophthalmitis was found, so statistical analysis was not possible for this endpoint. Further validation is required, but shorter ointment regimens may be a more feasible and equally efficacious alternative to extended drop regimens for routine vitrectomy.
This is a 2021 ARVO Annual Meeting abstract.