Abstract
Background: Topical corticosteroids have been the cornerstone in the management of postoperative inflammation following cataract surgery. Due to potential side effects of the older topical steroids like prednisolone acetate and dexamethasone or betamethasone, newer potent steroids preparation like difluprednate, loteprednol or fluorometholone are now being used at lesser dose and frequency to control inflammation. There is scanty literature on the efficacy of these drugs in preventing inflammation and macular oedema in the Indian population.Purpose: The purpose of this study was to compare the efficacy of difluprednate 0.05% against prednisolone 1% eye drops for control of inflammation following phacoemulsification. The adverse effects of both drugs were also evaluated in this retrospective study.Methods: This retrospective cohort study included 181 patients operated for age-related cataracts by a single surgeon at a tertiary referral eye hospital between December 2018 and March 2019. Patients received either difluprednate 0.05% emulsion (n=90 eyes) or prednisolone acetate 1% (n=91 eyes) after phacoemulsification with the same brand intraocular lens (IOL) and same phaco machine. The topical medication was initiated one day postoperatively and continued for six weeks in tapering dosage. Pain score (Visual Analogue Scale, VAS), conjunctival hyperemia, anterior chamber (AC) cell grading, corneal oedema, central retinal thickness, subclinical cystoid macular oedema (SCME), intraocular pressures (IOP) and best-corrected visual acuity (BCVA) were examined after one week and six weeks of cataract extraction. Results: There was no statistically significant difference observed with regards to pain score (no pain in any patients after six weeks), conjunctival hyperemia (no hyperemia in any patients after six weeks), AC inflammation (no reaction in any patients), central retinal thickness (234.44 ± 35.75µ vs. 234.8 ± 34.99µ, p-value 0.946), SCME (16.67% vs. 13.19%, p-value 0.511), IOP (16.8 vs. 15.47 mmHg, p-value 0.101) and BCVA (BCVA 6/6 in 57.7% vs. 70.32%, p-value >0.05) between both groups. The mean change in IOP in both the groups at one week (0 ± 4.4 vs. 1.87 ± 3.54, p-value 0.0007) and six weeks (−0.01 ± 5.53 vs. 1.88 ± 4.01, p-value 0.004) was significant. Conclusion: Both the groups were equivalent with regards to their therapeutic efficacy in controlling postoperative inflammation and restoration of vision following phacoemulsification.
Highlights
The latest, safest and most popular cataract extraction technique performed worldwide is phacoemulsification with posterior chamber intraocular lens implantation [1]
There was no statistically significant difference observed with regards to pain score, conjunctival hyperemia, anterior chamber (AC) inflammation, central retinal thickness (234.44 ± 35.75μ vs. 234.8 ± 34.99μ, pvalue 0.946), subclinical cystoid macular oedema (SCME) (16.67% vs. 13.19%, p-value 0.511), intraocular pressure (IOP) (16.8 vs. 15.47 mmHg, p-value 0.101) and best-corrected visual acuity (BCVA) (BCVA 6/6 in 57.7% vs. 70.32%, p-value >0.05) between both groups
The mechanical and ultrasonic energy induces breakdown of the ocular bloodaqueous barrier and thereby can potentially cause inflammation which manifests as conjunctival hyperemia, anterior chamber (AC) reaction, raised intraocular pressure (IOP) and cystoid macular oedema (CME) [2]
Summary
The latest, safest and most popular cataract extraction technique performed worldwide is phacoemulsification with posterior chamber intraocular lens implantation [1]. It involves minimal ultrasonic power and surgical tissue manipulation, lesser postoperative inflammation and early visual restoration [1]. Due to the potential adverse effects of the older topical steroids (prednisolone acetate, dexamethasone and betamethasone) on IOP and posterior sub-capsular cataract formation, newer potent steroid preparations like difluprednate, loteprednol and fluorometholone are preferred [8]. Due to potential side effects of the older topical steroids like prednisolone acetate and dexamethasone or betamethasone, newer potent steroids preparation like difluprednate, loteprednol or fluorometholone are being used at lesser dose and frequency to control inflammation. The adverse effects of both drugs were evaluated in this retrospective study
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
