Evaluation of inflammation and intraocular pressure after cataract surgery

Abstract

Lane and Holland1 have rightly compared 2 medications, loteprednol etabonate 0.5% and prednisolone acetate 1.0%, after cataract surgery. However, we would like to make a few observations. The intraocular pressure (IOP) after cataract surgery is affected by preoperative levels, the retained ophthalmic viscosurgical device (OVD), and the central corneal thickness (CCT). We know that CCT increases after phacoemulsification and recovers over time.2 Based on this knowledge, it is clear that postoperative corrected IOP is different from the uncorrected IOP. In the current study, we do not know that the CCT increase was the same in the 2 groups. The preoperative CCT level, effective phaco time, surgical time, use of OVD, and many other factors may affect the increase in CCT and its course. In addition, the amount of retained OVD can vary in multicenter studies. In the early postoperative period, the retained OVD may affect the IOP. The elevation of IOP due to OVD is marked at 6 to 24 hours,3 and the effect of OVD on IOP may take up to 72 hours.4 Therefore, we think evaluating corrected IOP early postoperatively and then 24 to 48 hours later will provide more clear results about the efficacy of loteprednol etabonate 0.5% and prednisolone acetate 1.0% on IOP changes. Another point that we want to share is the relationship of anterior chamber cell and flare intensity to the patient’s visual acuity, satisfaction, and comfort. Although statistically insignificant results or negligible differences between the 2 medications were reported, we have experienced red eye, sensitivity to light, and, rarely, fibrin reaction when loteprednol etabonate 0.5% was used as an initial treatment after cataract surgery. In these unfortunate conditions, patients are concerned about the success of the cataract surgery. In our practice, if the surgery is uneventful or patients have no glaucoma, we use prednisolone acetate 1.0% 4 times daily for 1 week, 3 times daily for the second week, and 2 times daily for 2 weeks. In glaucomatous eyes, in addition to antiglaucomatous medication, we use prednisolone acetate 1.0% 4 times daily for a week and then loteprednol etabonate 0.5% 4 times for the second week and 2 times for the next 2 weeks. In this manner, we use the advantages of these medications rather than their disadvantages.