Management of inflammation after the cataract surgery

Abstract

Purpose of reviewTo review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery.Recent findings FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most costeffective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drugloaded IOLs.

Assessment of the Retinal Ganglion Cell Layer after Uncomplicated Cataract Surgery

“…Pseudophakic cystoid macular edema (PCME) or Irvine–Gass syndrome is defined as intraretinal fluid in the form of cysts or central macular thickening. It remains the most common cause of decreased visual acuity after uncomplicated phacoemulsification [ 3 ]. Historically, PCME is defined with fluorescein angiography, for which the incidence was 9 to 19%.…”

Change in Subfoveal Choroidal Thickness following Cataract Surgery Imaged with Enhanced Depth Imaging Optical Coherence Tomography

“…Nevertheless, it is described in the literature that a reduction of surgical inflammation limits choroidal swelling. For example, Chen et al showed that the choroidal thickness increase was less pronounced in patients operated with a femtosecond laser, which is known to reduce the inflammatory strain on the eye [12,19]. Additionally, Cevher and Aydoğdu demonstrated that patients treated with nepafenac, an anti-inflammatory drug, had less choroidal swelling compared to controls [20].…”

“…What has to be considered when analyzing changes in choroidal thickness after surgery is the administration of anti-inflammatory drugs. The use of NSAIDs and prednisolone eye drops suppresses the release of cytokines to a certain extent, removing the possibility of measuring the true impact of cataract surgery on the posterior segment [19]. This was demonstrated by Cevher and Aydoğdu [20], who showed that the increase in choroidal thickness was smaller in patients treated with nepafenac compared to controls, although the difference was not statistically significant.…”