Single perioperative subconjunctival steroid depot versus postoperative steroid eyedrops to prevent intraocular inflammation and macular edema after cataract surgery

Dieleman, Myrthe; Wubbels, René J.; Kooten-Noordzij, Marina van; Waard, Peter W.T. de

doi:10.1016/j.jcrs.2011.03.049

Cited by 46 publications

(40 citation statements)

References 33 publications

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“…18 In previous studies, including one of 400 eyes, TA was shown not to differ from PA in postoperative intraocular pressure or incidence of postoperative inflammation 19,20 or macular edema. 21 We found no evidence that injected TA depot is less effective than topical administration of PA alone, although the number of macular edema cases with injected TA was small and the confidence intervals were wide. Injection appears to be safe, as well; we found no diagnoses of globe perforation and no increase in the risk of postoperative (“rebound”) iritis or differences in IOP spikes in the late postoperative period.…”

Section: Discussioncontrasting

confidence: 56%

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

et al. 2015

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PURPOSE To study the relationship of chemoprophylaxis and other factors on the occurrence of acute, clinical postoperative macular edema. DESIGN Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with nonsteroidal anti-inflammatory drug (PA+NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone. PARTICIPANTS Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, 2007–2013. METHODS Incident macular edema diagnoses recorded 5–120 days after phacoemulsification, with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography were identified. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy, other ocular comorbidities, systemic comorbidity and posterior capsular rupture. MAIN OUTCOME MEASURES Incident rates of acute, clinical, postoperative macular edema. RESULTS We confirmed 118 cases among 16,070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21–0.95) and for TA injection was 1.21 (95% CI, 0.48–3.06). The frequency of intraocular pressure spikes ≥30 mm Hg between postoperative days 16 – 45 was 0.6% in the topical PA group, 0.3% for topical PA+NSAID (p=0.13) and 0.8% for TA (p=0.52). African-American race was associated with risk of macular edema (OR, 2.86; 95% CI, 1.41–5.79). CONCLUSIONS Adding prophylactic NSAID to PA was associated with a reduced risk of macular edema with visual acuity 20/40 or worse. Risk and safety of TA injection was similar to PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, risk in African-Americans, and the effectiveness of depot medications.

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Section: Discussioncontrasting

confidence: 56%

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

et al. 2015

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“…The periocular drug delivery system can release dexamethasone sodium phosphate in a time-dependent manner in vitro in the 2 mg/ml and 5 mg/ml groups in vitro. In this study, we set the subconjunctival injection of DEXP as control group for subconjunctival injection is the easiest and most popular method among periocular injection routes applied by the ophthalmologists (Bali et al, 2010;Dieleman et al, 2011;Manandhar, 2011). However, in this study, DEXP can just persist in the eye for no longer than three days after subconjunctival injection, as no DEXP was detected in the eye three days after subconjunctival injection.…”

Section: Discussionmentioning

confidence: 95%

A study of the dexamethasone sodium phosphate release properties from a periocular capsular drug delivery system

et al. 2014

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The aim of this study was to investigate whether a periocular capsular drug delivery system (DDS) can release dexamethasone sodium phosphate (DEXP) in vitro and in vivo to the posterior segment of rabbit's eye. In vitro, the periocular capsular DDS containing 2 mg/ml or 5 mg/ml DEXP was immersed in modified Franz diffusion cell. Four-hundred microliters of liquid was aspirated at 0.5, 1, 2, 4, 8, 24 and 48 h for determination. In vivo, the DEXP-filled periocular capsular DDS was implanted into the sub-Tenon's sac of the New Zealand rabbit. DEXP concentration at the serum aqueous humor, cornea, iris, lens, ciliary body, vitreous, retina, choroids and sclera was quantified at 1, 3, 7, 14, 28 and 56 d after implantation. The DEXP concentration was determined by ultra-performance liquid chromatography-tandem mass spectrometry. In vitro, the periocular capsular DDS released the DEXP in time-dependent manner from 1/2 to 48 h. In vivo, the concentrations of the DEXP at the retina, choroids, ciliary body and iris were 123.11 (91.23, 732.61) ng/g, 362.46 ± 330.46 ng/g, 71.64 (71.35, 180.21) ng/g and 192.50 ± 42.66 ng/g, respectively, at 56 d after implantation. Minimal DEXP was found in the aqueous, serum and vitreous. Our results demonstrated that DEXP could be sustained released from the periocular capsular DDS, which indicated that the periocular capsular DDS might be a potential candidate of transscleral drug delivery for the management of posterior segment diseases.

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“…OCT images were generated with the use of six radial-line scans, 6.00 mm each in length. The maximal foveal center point thickness (in micrometers) was measured at the center point of the fovea by manually placing computerized calipers at the vitreous-retina and retina-retinal pigment epithelium interfaces [5, 17]. …”

Section: Methodsmentioning

confidence: 99%

“…Macular edema was defined as an increase in the center point thickness of more than 30% from preoperative baseline on OCT 4 weeks after cataract surgery [5, 17]. All patients were divided into either the macular edema group [ME (+)] or nonmacular edema group [ME (−)].…”

Section: Methodsmentioning

confidence: 99%

“…However, anterior segment inflammation, progression of diabetic retinopathy, and macular edema (ME) are the most common complications in patients with diabetes following uncomplicated phacoemulsification cataract surgery [3, 4]. ME is one of the main causes of unfavorable visual outcomes following uncomplicated cataract surgery and can result in permanent visual loss [5–7]. The reported incidence of ME ranges from 20% to 50% in patients with diabetes following uncomplicated phacoemulsification cataract surgery [8, 9].…”

Section: Introductionmentioning

confidence: 99%

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Aqueous Cytokines as Predictors of Macular Edema in Patients with Diabetes following Uncomplicated Phacoemulsification Cataract Surgery

Dong

Wang

et al. 2015

BioMed Research International

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This study aims to ascertain whether cytokines in the aqueous humor can predict macular edema (ME) in diabetic patients following uncomplicated phacoemulsification cataract surgery. Undiluted aqueous humor samples were obtained from 136 consecutive type 2 diabetic patients who underwent cataract surgery. The concentrations of 27 cytokines were measured in aqueous humor using the multiplex bead immunoassay. At the final follow-up examination, 116 patients completed 4 weeks of follow-up, and the incidence of macular edema was 29.31% (34 patients) 4 weeks after cataract surgery. Compared to the ME (−) patients, the concentrations of interleukin-1β (IL-1β) (P < 0.001), IL-6 (P < 0.001), IL-8 (P < 0.001), interferon-induced protein-10 (IP-10) (P = 0.003), monocyte chemotactic protein-1 (MCP-1) (P < 0.001), and vascular endothelial growth factor (VEGF) (P < 0.001) in the ME (+) patients were significantly higher. In addition, the aqueous levels of IL-1β (r = 0.288), IL-6 (r = 0.345), IL-8 (r = 0.256), IP-10 (r = 0.377), MCP-1 (r = 0.423), and VEGF (r = 0.279) were positively correlated with the postoperative foveal center point thickness (FCPT). However, the aqueous levels of IL-10 (P = 0.003) and IL-12 (P = 0.017) were significantly lower in patients with ME. These results suggest IL-1β, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, and VEGF may be potential predictors of postoperative macular thickness in patients with diabetes following uncomplicated phacoemulsification cataract surgery.

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Single perioperative subconjunctival steroid depot versus postoperative steroid eyedrops to prevent intraocular inflammation and macular edema after cataract surgery

Abstract: A single subconjunctival betamethasone acetate injection appears to be a useful alternative to prolonged postoperative administration of dexamethasone eyedrops in controlling intraocular inflammation and development of macular edema after phacoemulsification.

Cited by 46 publications

References 33 publications

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

A study of the dexamethasone sodium phosphate release properties from a periocular capsular drug delivery system

Aqueous Cytokines as Predictors of Macular Edema in Patients with Diabetes following Uncomplicated Phacoemulsification Cataract Surgery

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