J Cataract Refract SurgMay 202212 citations

Safety and efficacy of topical vs intracanalicular corticosteroids for the prevention of postoperative inflammation after cataract surgery.

Lu Amy Q, Rizk Monica, O'Rourke Tara, Goodling Kristin, Lehman Erik, Scott Ingrid U, Pantanelli Seth M

View on PubMed DOI: 10.1097/j.jcrs.0000000000000963

AI Summary

This study compared topical prednisolone to intracanalicular dexamethasone for post-cataract inflammation. Both methods showed similar rates of breakthrough inflammation and IOP elevation, suggesting the insert is a comparable alternative for prophylaxis.

Abstract

Purpose

To compare the safety and efficacy of topical prednisolone and intracanalicular dexamethasone ophthalmic insert for the prevention of postoperative inflammation after cataract surgery.

Setting

Penn State College of Medicine, Hershey, Pennsylvania.

Design

Retrospective consecutive case series.

Methods

Patients scheduled for elective phacoemulsification cataract surgery with a plan to receive inflammation prophylaxis with topical prednisolone (prednisolone acetate 1 mg/1 mL) between January 2018 and November 2019 or intracanalicular dexamethasone (Dextenza, 0.4 mg) between December 2019 and March 2021 were screened. Patients were seen 1 day, 1 week, and 4 to 16 weeks postoperatively. Medical records were also reviewed for any urgent messages between visits. Primary end points were proportion of eyes with (1) breakthrough inflammation requiring escalation of anti-inflammatory therapy and (2) intraocular pressure (IOP) increase ≥10 mm Hg at 4 to 16 weeks of follow-up. Secondary end points included incidence of intraoperative complications, cystoid macular edema, and infectious sequelae.

Results

358 patient charts (358 eyes) were screened. Of these, 262 eyes of 262 patients met the criteria for inclusion in the study; 131 eyes received topical drops, and 131 eyes received the intracanalicular insert. Among eyes that completed follow-up, 9 eyes (6.9%) in the drops group and 12 eyes (9.2%) in the insert group experienced breakthrough inflammation necessitating treatment ( P = .50). 2 eyes in the drops group and 1 eye in the insert group had elevated IOP.

Conclusions

Postoperative inflammation prophylaxis with the intracanalicular insert may be associated with similar rates of breakthrough inflammation and IOP elevation as topical drops.

MeSH Terms

HumansRetrospective StudiesVisual AcuityPhacoemulsificationPrednisoloneCataractAdrenal Cortex HormonesInflammationDexamethasonePostoperative ComplicationsIntraocular PressureOphthalmic Solutions

Shields Classification

Ch. 22Glaucomas Associated with Ocular Inflammation

Ch. 25Glaucomas Associated with Ocular Trauma

Ch. 28Principles of Medical Therapy for Glaucoma

Key Concepts3

In a retrospective consecutive case series of 262 eyes (262 patients) undergoing cataract surgery, 9 eyes (6.9%) in the topical prednisolone group and 12 eyes (9.2%) in the intracanalicular dexamethasone insert group experienced breakthrough inflammation necessitating treatment (P = .50).

Comparative EffectivenessCase seriesRetrospective Consecutive Case Seriesn=262 eyes of 262 patientsCh27Ch28Ch29

In a retrospective consecutive case series of 262 eyes (262 patients) undergoing cataract surgery, 2 eyes in the topical prednisolone group and 1 eye in the intracanalicular dexamethasone insert group had elevated intraocular pressure.

Comparative EffectivenessCase seriesRetrospective Consecutive Case Seriesn=262 eyes of 262 patientsCh3Ch24Ch27

Postoperative inflammation prophylaxis with the intracanalicular dexamethasone insert may be associated with similar rates of breakthrough inflammation and intraocular pressure elevation as topical prednisolone drops after cataract surgery.