Post-surgical management of cataract: Light and dark in the 2020s

Abstract

Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.

Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013–2019

“…Nowadays, postoperative administration of topical antibiotics in noncomplicated cataract surgery, the most common clean surgery in ophthalmology, is a standard procedure that prevents and lowers endophthalmitis rates. However, some ophthalmologists use antibiotics in preoperative care, before the surgery, which is not proven to be beneficial for patients [ 16 , 17 , 18 ]. Moreover, in different ocular procedures, such as intravitreal injections, antibiotics administration is contraindicated [ 19 ].…”

Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot study

“…Eye drop self-administration obstacles have also been reported due to physical limitations and preservatives discomfort. Therefore, administration of topical prophylaxis may be handed to caregivers which also translates to a burden to them as they adjust their personal schedule to accommodate the post-operative needs of their relatives, including post-surgical transportation to the pharmacy to acquire the medications promptly [ 6 , 20 , 21 ]. During this study, physician-administered injections at the end of surgeries has decreased the burden to patients and caregivers, particularly in the elderly population, by removing the need for drop administration, eliminating drop-related discomfort, and reducing costs with only a $5 cost per patient that the surgical center covers as part of the total standardized current procedural terminology (CPT) surgery center fee.…”

Role of fixed-dose combinations of antibiotics and steroids in ophthalmic surgery

“…Таким образом, антибактериальный эффект ВВА цефуроксима исчезает в течение 1-х суток после операции. Как следствие, избежать контаминации ВВ в последующие 7 дней можно либо путем безукоризненного соблюдения пациентами реко-мендаций, предотвращающих наружную фильтрацию (что не всегда осуществимо [14]), либо назначать после ФЭ топическую антибиотикотерапию [15].…”

“…Поскольку несвоевременно начатое и/или неадекватное лечение ОЭ приводит к катастрофическим последствиям, крайне важно использовать наиболее эффективный АБП [14], обеспечивающий значительно превышающую МПК концентрацию в конъюнктивальной полости и передней камере на протяжении недели, требующейся для эпителизации роговичного разреза [6,16]. К сожалению, оптимальный и рекомендуемый европейскими экспертами по местной послеоперационной профилактике эндофтальмита (EUREQUE) [14] антибиотик для предупреждения внутриглазной инфекции до сих пор не определен.…”

“…Контроль воспаления является второй основной задачей послеоперационного лечения, наиболее эффективным способом решения которой служит применение топических ГК -в частности, дексаметазона с его мощным противовоспалительным потенциалом [22]. Фиксированные комбинации дексаметазона и АБП могут стать действенным инструментом повышения комплаентности, особенно среди пожилых пациентов [14,23]. Однако рациональные алгоритмы использования ФК АБП и ГК до сих пор не выработаны, многие офтальмологи удлиняют лечение до 2 нед.…”