Reply: Evaluation of inflammation and intraocular pressure after cataract surgery

Abstract

Drs. Erhan and Pelin Özyol are correct that our study did not “correct” for IOP, and we also agree that IOP is dependent on the many factors mentioned in their letter. Although a “corrected” IOP may indeed give a more accurate representation of the magnitude of the pressure, our study looked at the delta or change in pressure from baseline, specifically looking at more long-term IOP changes that might indicate a greater steroid response in one group than in the other.1,2 Postoperative short-term IOP changes (less than 1 week) could indicate surgical factors such as changes in CCT due to edema, but longer-term IOP changes would not. It is a reasonable assumption that postoperative CCT will be similar to baseline (there were no cases of clinical corneal edema) by day 21 and as such would be an accurate representation of change in IOP. Furthermore, it has been shown that in more extreme cases of changes in CCT, such as following laser in situ keratomileusis or photorefractive keratectomy, IOP changes are in the 2 to 3 mm Hg magnitude. Even under this extreme case, it would not be statistically significant. Our study showed no statistically significant difference in IOP between topical prednisolone and loteprednol, and there is no reason to think there would be a different result with a corrected IOP measurement. With regard to Drs. Erhan and Pelin Özyol’s personal experiences of postsurgery inflammation in some cases, their observations are just that—observations. Unfortunately, this perpetuates the myth that there is a reduced antiinflammatory effect postoperatively in cataract surgery with loteprednol. A myth we have disproved by our study. Finally, their practice of using 2 different steroids postoperatively after cataract surgery adds to the expense of surgery and, based on our study, is unnecessary.