Abstract
Purpose :
To determine the safety of an intracanalicular dexamethasone ophthalmic insert (IDOI) combined with topical Ketorolac tromethamine 0.5% (ketorolac) to prevent breakthrough inflammation (iritis or cystoid macular edema) after cataract surgery, compared to topical prednisolone acetate 1% (PA) taper and ketorolac over the first post-operative month (POM1) in patients susceptible to post-operative increased inflammatory response.
Methods :
Retrospective study of consecutive uncomplicated cataract surgeries between June 2000 and March 2023 at the Kellogg Eye Center in Michigan, USA. Patients received either IDOI and ketorolac or PA and ketorolac (control) during POM1. Exclusion criteria included history of iritis, intraoperative posterior capsular rupture or vitreous prolapse, premature implant dislodgement, self-taper of steroid drops, or less than 1 month follow up post-operatively. Outcomes included development of breakthrough inflammation necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1.
Results :
33 eyes of 22 patients were included in the IDOI/ketorolac group, and 43 eyes of 34 individuals in the control. Demographics, ocular comorbidities, and baseline IOP were comparable between groups. There were no differences between groups in the preoperative presence of epiretinal membrane (54.5% vs 53.5%, p>0.99) or history of diabetic retinopathy (30.3% vs 27.9%; p>0.99) in the surgical eyes. There was no statistical difference in the postoperative rate of rebound inflammation in the IDOI/ketorolac compared to the PA/ketorolac group (6.1% vs 2.3%; p=0.58). There were no cases of cystoid macular edema or increased IOP >10mmHg at POM1 compared to baseline in either group.
Conclusions :
After cataract surgery, IDOI/ketorolac shows slightly higher rates of rebound inflammation than PA/ketorolac regimen with no significant differences in CME rates or in IOP increase frequency; however, overall, the rate of postoperative complications was low. IDOI can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery when combined with a non-steroidal agent in patients susceptible to an increased inflammatory response due to pre-existing ocular comorbidities.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.