Efficacy and safety of intracameral triamcinolone acetonide to control postoperative inflammation after phacotrabeculectomy

Wang, Bingsong; Dong, Ning; Xu, Bing; Liu, Jing; Lin, Xinfeng

doi:10.1016/j.jcrs.2013.04.042

Cited by 20 publications

(27 citation statements)

References 21 publications

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“…The literature review identified one prospective RCT on glaucoma surgery that fulfilled the predetermined criteria (

true0 \geq

40 patients, endpoint measured at 2 weeks, cell and flare scoring) 48. This trial randomised patients with primary open-angle glaucoma or primary angle-closure glaucoma who were undergoing combined trabeculectomy plus phacoemulsification lensectomy to receive one of three doses of intracameral preservative-free triamcinolone acetonide (0.5 mg, 1.0 mg or 2.0 mg) or a control (subconjunctival dexamethasone 3 mg).…”

Section: Resultsmentioning

confidence: 99%

Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey

Aptel

Colin

Kaderli³

et al. 2017

Br J Ophthalmol

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Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye's inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines.

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“…The literature review identified one prospective RCT on glaucoma surgery that fulfilled the predetermined criteria (

true0 \geq

Section: Resultsmentioning

confidence: 99%

Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey

Aptel

Colin

Kaderli³

et al. 2017

Br J Ophthalmol

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“…; Wang et al. ). All studies but one reported on the number of postoperative antiglaucomatous medications (Starita et al.…”

Section: Level Of Evidencementioning

confidence: 98%

“…), and in the second study, patients underwent phacotrabeculectomy (Wang et al. ). Both studies used MMC.…”

Section: Summary Of Evidencementioning

confidence: 99%

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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Surgical outcome after trabeculectomy depends on maintaining a functional bleb which requires a delicate balance between incomplete wound healing to prevent fibrosis and enough wound healing to prevent hyperfiltration. Thus, controlling the inflammatory response is essential. We conducted a systematic review and meta-analysis to compare the effectiveness of different formulations of steroids (topical, systemic and depot) and nonsteroidal anti-inflammatory drugs (NSAIDs) in achieving long-term pressure control with fewer antiglaucomatous medications, preserving visual acuity and visual fields while considering surgical and postoperative complications. We used the PubMed, EMBASE and Cochrane Libraries to identify randomized controlled trials (RCTs) comparing the effect of different formulations of steroids (topical, systemic or depot) to NSAIDs. Data on prespecified outcomes from eligible references were entered into a meta-analysis using the Review Manager 5.3 program. We identified seven RCTs with a total of 342 included patients. Topical steroids were superior to placebo in controlling intraocular pressure (IOP) and reducing the risk of complications. Supplementing topical steroids with a perioperative steroid depot (subtenon or intracamerally) or systemic steroids in the early postoperative period did not provide better outcome or a change in the risk of complications. Addition of topical NSAIDs to topical steroids in patients undergoing trabeculectomy did not change the outcome or risk profile. For patients undergoing phacotrabeculectomy and topical NSAID, there was a nonsignificant trend towards better intermediate IOP control and a reduced need for antiglaucomatous medications compared to topical steroids but there was no difference in effect for patients undergoing trabeculectomy. In conclusion, there is a low level of evidence to support the clinician in deciding which postoperative regime provides a more favourable outcome because of inconsistency in the reported outcomes between studies and a low number of patients for each comparable intervention and outcome. It does seem that topical steroids are better than no antiinflammatory treatment after glaucoma surgery, but further research is recommended.The authors are grateful for the help of information specialist Karine Korsgaard with the literature search.

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“…Triamcinolone and other corticosteroids have clinically been applied as intravitreal application for the therapy of many intraocular edematous diseases such as diabetic macular edema and retinal vein occlusions. [79][80][81][82][83][84] Chinese medicinal herbs have also been reported to have an effect on activated microglia. 85 Scutellarin is a natural flavone glucuronide which is extracted from Erigeron breviscapus.…”

Section: Microglia-targeted Therapymentioning

confidence: 99%

Retinal Microglia in Glaucoma

Wang

Chen

Zhang

et al. 2016

Journal of Glaucoma

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Efficacy and safety of intracameral triamcinolone acetonide to control postoperative inflammation after phacotrabeculectomy

Cited by 20 publications

References 21 publications

Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey

Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Retinal Microglia in Glaucoma

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