Effect of anti-inflammatory regimen on early postoperative inflammation after cataract surgery. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Erichsen, Jesper H.; Forman, Julie L.; Holm, Lars M.; Kessel, Line
• Is Part Of: Journal of cataract and refractive surgery. Volume 47:Issue 3(2021)
• Page Start: 323
• Page End: 330
• Publication Date: 2021-03
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000000455
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : Combination of prednisolone and NSAID eyedrops is not better than NSAID monotherapy in controlling early postoperative inflammation after standard cataract surgery. NSAID monotherapy may be preferred. Abstract : Purpose: To investigate whether a combination of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a sub-Tenon depot of steroid was placed during surgery. Setting: Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark. Design: Prospective randomized controlled trial with masked statistical analyses. Methods: Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eyedrops combined (Pred+NSAID-Pre [control group] and Pred+NSAID-Post group) vs ketorolac monotherapy (NSAID-Pre and NSAID-Post groups) vs sub-Tenon depot of dexamethasone (dropless group). Drops were used until 3 weeks postoperatively, starting 3 days preoperatively in the Pre groups and on the day of surgery in the Post groups. Aqueous flare was measured at baseline and 3 days postoperatively. Results: Four hundred fifty-six participants, with a mean age of 72.1 (SD 7.0) years and 283 (62%) women, were included. Flare increased significantly more in the dropless group compared with the control group (Pred+NSAID-Pre), but none of the other groups differed significantly from the control group. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eyedrops (Pred+NSAID-Pre and Pred+NSAID-Post groups) compared with NSAID monotherapy and dropless groups. No differences in postoperative visual acuity were found compared with the control group. Conclusions: No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery, but sub-Tenon depot of dexamethasone was less efficient. Initiating prophylactic eyedrops prior to surgery did not influence early postoperative anterior chamber inflammation.