Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide

Abstract

Purpose: To evaluate the efficacy and safety of topical dexamethasone (DEX) eye drops in combination with a single perioperative subtenon triamcinolone acetonide (sTA) injection versus conventional topical DEX eye drops in the prevention of ocular inflammation and cystoid macular edema following cataract surgery. Materials and methods: Medical records of 245 eyes of 245 patients who underwent uncomplicated cataract surgery were analyzed in this retrospective controlled clinical study. Topical DEX eye drops were administered to 128 eyes routinely postoperatively, and 117 eyes were given a single dose of sTA (40 mg/ml) together with topical DEX eye drops for postoperative care. Postoperative topical antibiotic prophylaxis was applied to all eyes. The primary outcomes were anterior chamber (AC) cells and flare, central macular thickness (CMT), best corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements on day 7, day 30, day 90, and day 180 following surgery. Results: Although CMT increased in the DEX group, no increment was observed in the DEX þ sTA treated group for all follow-up periods (on day 7 (þ1.3 ± 18.6 and À8.7 ± 21.9 lm, p ¼ 0.038), on day 30 (þ20.5 ± 58.4 and À4.1 ± 25.2 lm, p ¼ 0.009), on day 90 (þ7.2 ± 19.9 and À5.7 ± 30.6 lm, p ¼ 0.029), and on day 180 (þ8.2 ± 22.6 and À6.4 ± 32.9 lm, p ¼ 0.032)). There was no significant difference in terms of AC cells and flare between the two groups during the entire follow-up period (p > 0.05). Significant improvement in BCVA was observed in the DEX þ sTA group at day 30 (p ¼ 0.008). IOP differences were comparable, and both groups had high ocular tolerance. There were no severe adverse effects recorded. Conclusions: Topical DEX eye drops in combination with single dose perioperative injection of sTA have robust efficacy in preventing ocular inflammation and the development of cystoid macular edema following uncomplicated cataract surgery.

Steroid Response Following Dropless Cataract Surgery Using Subconjunctival Triamcinolone

“… 33–36 Prior studies on dropless cataract surgery using triamcinolone injected approximately 3.5 mm or 10 mm posterior to the limbus did not result in greater risk for IOP increase postoperatively. 2 , 28 Our injection distance was within range of these studies, at 5 mm posterior to the limbus. Herschler 34 reported on a small series of 13 eyes receiving 40 mg of triamcinolone for various inflammatory conditions, 10 of which were in the anterior sub-Tenon’s space, and all 10 of which experienced an IOP increase.…”

“…Steroid depot injections may provide better postoperative inflammation control than topical steroid drops alone, though findings from existing studies are mixed. [3][4][5][6]28 Several studies have found that eyes receiving steroid injections have lower incidence of cystoid macular edema (CME) following cataract surgery, but there were no significant visual acuity differences between the steroid depot and topical steroid groups on postoperative follow-up. 3,28 Other studies found no significant difference in CME but did find lower rates of anterior chamber cell and flare, without a difference in postoperative visual acuity between steroid depot and topical steroid eyes (although the study examiners were not blinded to the type of steroid patients received).…”

“…[3][4][5][6]28 Several studies have found that eyes receiving steroid injections have lower incidence of cystoid macular edema (CME) following cataract surgery, but there were no significant visual acuity differences between the steroid depot and topical steroid groups on postoperative follow-up. 3,28 Other studies found no significant difference in CME but did find lower rates of anterior chamber cell and flare, without a difference in postoperative visual acuity between steroid depot and topical steroid eyes (although the study examiners were not blinded to the type of steroid patients received). 4,6 While we did not have OCT data for all eyes in our study to assess the presence of CME, we did not find any difference between dropless and conventional groups with respect to requiring additional steroids in the postoperative period for inflammation control.…”

Development of Triamcinolone Acetonide Nanocrystals for Ocular Administration

“…In turn, TA-NC exhibited a superior effect on fogginess attenuation than Fortcinolona ® 40 at the same dose, which could be explained by the higher drug saturation concentration that allows a larger amount of available dissolved molecules to exert a pharmacological effect. Similarly, the demonstrated therapeutic efficacy of TA-NC was achieved in this in vivo model by testing half the dose typically used for injection of TA nanosuspensions [ 34 , 35 , 36 , 37 ] such as off-label Fortcinolona ® 40 in the clinical treatment of ocular inflammations such as uveitis. Thus, TA-NC could result in a promising approach to administering lower doses of corticosteroids or decreasing the frequency of administration of the therapeutic scheme.…”