Anterior Segment Inflammation Research Articles

Therapeutic Effect of 0.03% Tacrolimus Ointment for Ocular Graft versus Host Disease and Vernal Keratoconjunctivitis

PurposeTo determine whether topical tacrolimus might prove effective in the treatment of refractory anterior segment inflammatory diseases, and to evaluate its efficacy in eyes with ocular graft versus host disease (GVHD), and vernal keratoconjunctivitis (VKC).MethodsTwenty-eight eyes of 14 patients with anterior segment inflammation refractory to steroid treatment were treated with 0.03% tacrolimus ointment at the Samsung Medical Center, Seoul, Korea from March 2008 through August 2009. Seven patients had ocular GVHD and seven had VKC. We evaluated the conjunctival and corneal inflammatory change at one, two, four, and eight weeks after treatment with a scoring system. Time to initial response of treatment and therapeutic effect between GVHD and VKC was also analyzed. After the eight-week treatment period, patients were divided into two groups (maintenance group and discontinuance group). Eight patients maintained the treatment for an additional four months, and six patients discontinued the treatments. Therapeutic effect was also compared between the groups at eight weeks and six months after treatment.ResultsThe mean conjunctival and corneal inflammation score was reduced significantly at eight weeks after treatment (p < 0.0001). The therapeutic effect in conjunctival inflammation was first noted at week two after the initial treatment (p = 0.002); reduction in corneal inflammation was first noted at one week (p = 0.0009). When compared according to diagnosis, no therapeutic difference was detected between the groups (p > 0.05). Six months after treatment, we noted no therapeutic differences between the maintenance group and discontinuance group (p > 0.05).Conclusions0.03% tacrolimus ointment was safe and effective for use in anterior segment inflammatory disease refractory to steroid.

Advances in Corticosteroid Therapy for Ocular Inflammation: Loteprednol Etabonate

Topical corticosteroids are effective in reducing anterior segment inflammation but are associated with adverse drug reactions (ADRs) including elevation of intraocular pressure (IOP) and cataract formation. Retrometabolic drug design has advanced the development of new corticosteroids with improved therapeutic indices. Engineered from prednisolone, loteprednol etabonate (LE) has a 17α-chloromethyl ester, in lieu of a ketone group, and a 17β-etabonate group. LE is highly lipophilic and binds with high affinity to the glucocorticoid receptor; any unbound LE is metabolized to inactive metabolites. LE has been studied in several anterior segment inflammatory conditions (giant papillary conjunctivitis, allergic conjunctivitis, anterior uveitis, and keratoconjunctivitis sicca), and in postoperative ocular inflammation and pain. Combined with tobramycin, it is effective in blepharokeratoconjunctivitis. Elevations in IOP are infrequent with LE, and the absence of a C-20 ketone precludes formation of Schiff base intermediates with lens proteins, a common first step implicated in cataract formation with ketone steroids.

The impact of cataract on the quantitative, non-invasive assessment of retinal blood Flow

The aim of the study was to determine the impact of cataract on the quantitative, non-invasive assessment of retinal blood flow assessed by bidirectional laser Doppler flowmetry and simultaneous vessel densitometry. Ten patients scheduled for extracapsular cataract extraction using phacoemulsification and intraocular lens implantation between the ages of 61 and 84 (mean age 73 years, SD ± 8) were prospectively recruited. Two visits were required to complete the study; one visit prior to extracapsular cataract extraction and one at least 6 weeks after the surgery to allow for sufficient postoperative recovery. The severity of cataract was documented using the Lens Opacity Classification System (LOCS, III) at the first visit. Retinal arteriolar hemodynamics were measured at both visits using the high-intensity setting of the Canon Laser Blood Flowmeter. All eyes showed no clinical signs of postoperative intraocular inflammation. The quantitative assessment of retinal arteriolar diameter and blood flow were reduced following extracapsular cataract extraction (Wilcoxon signed-rank test, p = 0.022 and p=0.028, respectively); however, centreline blood velocity was not significantly changed (Wilcoxon signed-rank test, p=0.074). Intraocular pressure was unchanged pre- and postcataract extraction. Retinal vessel densitometry assessment in the presence of cataract results in the erroneous elevation of the diameter measurement and thereby the calculation of blood flow. The bidirectional Doppler assessment of blood velocity appears to be more robust to light scatter induced by cataract. Care needs to be exercised in the interpretation of studies of retinal vessel diameter or blood flow that utilize similar densitometry techniques.

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

To compare the efficacy of dexamethasone 0.1% eyedrops after phacoemulsification versus a single perioperative subconjunctival injection of betamethasone acetate 5.7 mg/mL to prevent anterior segment inflammation and macular edema. Rotterdam Eye Hospital, Rotterdam, The Netherlands. Randomized clinical trial. Patients scheduled for cataract surgery were randomly assigned to receive a perioperative subconjunctival injection of betamethasone acetate 5.7 mg/mL (Group 1) or postoperative administration of dexamethasone 0.1% eyedrops (Group 2). Primary outcomes were foveal thickness and macular edema on optical coherence tomography (OCT) and anterior chamber flare by a laser flare meter preoperatively and 4 weeks postoperatively. Secondary outcomes were intraocular pressure, need for additional outpatient clinic visits, phacoemulsification energy, verbal-rating pain scale, and corrected distance visual acuity. The study enrolled 400 patients (400 eyes). Four weeks postoperatively, the mean flare values were significantly higher in Group 1 than in Group 2 (P=.003). The incidence of macular edema on OCT and clinically significant macular edema were not significantly different between groups (P=.685 and P=.386, respectively). No significant difference was observed in any other outcome measure. 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.

Clinical Features and Diagnostic Evaluation of Biopsy-Proven Ocular Sarcoidosis

To compare the clinical characteristics of uveitic sarcoidosis in African American and non-African American patients with biopsy-proven sarcoidosis and to determine which diagnostic test results were most often suggestive of sarcoidosis in patients who were ultimately diagnosed as having the disease. Retrospective review of consecutive patients with biopsy-proven sarcoidosis evaluated by the uveitis service between 1989 and 2009. A total of 63 patients with uveitic sarcoidosis were identified: 39 (62%) were African American (P <.001) and 43 (68%) were female. African American patients presented at an earlier age (P <.001) and were more likely to have granulomatous anterior segment inflammation (P <.001). The levels of serum markers angiotensin-converting enzyme and lysozyme were elevated in 40% and 42% of patients tested, respectively. The levels of at least 1 marker were elevated in 18 patients (58%). Imaging study results were reported as consistent with sarcoidosis in 25 patients (69%) who underwent chest radiography and in 19 patients (100%) who underwent computed tomography. In this series, African American patients were more likely to be diagnosed as having uveitic sarcoidosis and to present with uveitis if they were younger than 50 years. White patients were more likely to present when they were older than 50 years. A clinical picture that included granulomatous anterior segment inflammation was more common in African American patients. The use of serum markers (angiotensin-converting enzyme and lysozyme) positively identified more patients with biopsy-proven sarcoidosis when used in combination with appropriate chest imaging.

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Comparing Three Post-Op Regiments for Management of Inflammation Post Uncomplicated Cataract Surgery. “Are Steroids Really Necessary?”

Purpose: To compare intraocular pressure (IOP) differences; degrees of anterior chamber inflammation and macular edema between three different treatments. Setting: Single center, private, teaching practice in Las Vegas, Nevada. Methods: Prospective, randomized, single-blind study. Patients in the Control group received gatifloxacin 0.3%, prednisolone acetate 1%, and bromfenac 0.09%; Group #I received gatifloxacin and bromfenac; and Group #II was given one intraoperative steroid (Triamcinolone) injection and gatifloxacin and bromfenac in the post-operative period. Results: Elevated IOPs were noted on post-operative day one but were statistically insignificant (p=0.15). The elevated IOPs were statistically significant for the glaucoma patients (p=0.004). All IOPs returned to baseline after 1 week The degree of anterior segment inflammation was not statistically significant (p=0.39) between the studied populations. The foveal thickness (FT) was used to determine the degree of macula inflammation. The degree of macula inflammation was not statistically significant between the three groups (p=0.82). Conclusions: This study demonstrated efficacy between the three regimens in decreasing and resolving anterior chamber inflammation and preventing the development of macular edema. The intraocular spikes although more significant on post-operative day 1, returned to baseline by the one week post-surgery visit.

Syndromes toxiques du segment antérieur

Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells.

Toxic anterior segment syndrome after pediatric cataract surgery

Toxic anterior segment syndrome is an acute, sterile, anterior segment inflammation that occurs after any anterior segment surgery. The condition is an increasingly recognized complication of adult cataract surgery. Here we report the clinical findings of a case of toxic anterior segment syndrome in a child after uneventful congenital cataract surgery.

Intracameral triamcinolone acetonide after pediatric cataract surgery

To assess the use of preservative-free intracameral triamcinolone as an adjunct to topical steroidal agents after pediatric cataract surgery. Children's University Hospital, Dublin, Ireland. Retrospective case series. From the 2008 to 2009, intracameral preservative-free triamcinolone 4 mg/0.1 mL (Triesence) was used immediately after cataract surgery. Clinical indices of anterior segment inflammation were assessed at 1, 7, 14, 21 days and at 6 weeks postoperatively. There were no complications secondary to triamcinolone use in 36 eyes of 26 children. In all but 1 case, intracameral triamcinolone was highly effective in controlling postoperative inflammation after pediatric cataract surgery, resulting in quiet eyes with few inflammatory signs (grade 0 to 1). Intracameral triamcinolone provided a safe and useful adjunct to topical steroid drops after pediatric cataract surgery.

Paraneoplastic Exudative Retinal Detachment Associated with Adenocarcinoma of the Lung

To report a case of bilateral paraneoplastic exudative retinal detachment (ERD) associated with asymptomatic adenocarcinoma of the lung. Case report. A 47-year-old man presented with bilateral ERD accompanied by anterior and posterior segment inflammation. Extensive investigations for local and systemic causes of ERD were unrewarding. Only when computed tomography scanning of the thorax was performed were enlarged thorax lymph nodes demonstrated and revealed biopsy-proven adenocarcinoma. Paraneoplastic phenomena should be considered in patients presenting with ERD. Ocular paraneoplastic pathologies may be the initial manifestation of an underlying malignancy.

Outcomes of cataract surgery and intraocular lens implantation with and without intracameral triamcinolone in pediatric eyes

To evaluate whether intracameral triamcinolone has an effect on anterior segment inflammation and visual axis obscuration after pediatric cataract surgery with intraocular (IOL) implantation. Iladevi Cataract and IOL Research Institute, Ahmedabad, India. This retrospective age-matched case-control study comprised consecutive eyes of children having phacoaspiration, posterior capsulectomy, vitrectomy, and IOL implantation. In the study group, eyes received a standardized application of an intracameral preservative-free triamcinolone acetonide suspension intraoperatively. In the control group, age-matched consecutive eyes had surgery with a similar technique but without intracameral preservative-free triamcinolone acetonide. Cell deposits, posterior synechias, visual axis obscuration, and intraocular pressure (IOP) were evaluated 1 month and 12 months postoperatively. The mean patient age at surgery was 9.15 months +/- 5.04 (SD) in the study group (41 eyes) and 9.34 +/- 5.10 months in the control group (83 eyes) (P = .91). The visual axis was not obscured in any eye in the study group, while 9 eyes (10.8%) in the control group had an obscured axis; the difference between groups was statistically significant (P<.029). Six eyes (7.2%) in the control group required secondary membranectomy with pars plana vitrectomy. There was a statistically significant difference between the 2 groups in posterior synechias and cell deposits (both P<.033) and no significant difference in preoperative or postoperative IOP (P = .29 and P = .50, respectively). Pediatric eyes receiving intracameral triamcinolone intraoperatively had significantly less anterior segment inflammation and no visual axis obscuration after cataract surgery with IOL implantation.

Floppy Eyelid Syndrome as a Subset of Lax Eyelid Conditions: Relationships and Clinical Relevance (an ASOPRS Thesis)

To better define the wide spectrum of lax eyelid conditions, especially the subtype referred to as floppy eyelid syndrome, and to clarify its relationship with associated ophthalmic findings. A case-based retrospective review of all patients seen at UNC Department of Ophthalmology with a diagnosis of floppy eyelid syndrome or lax upper eyelid was performed. The period of review was from March 2002 to March 2007. A literature review was also performed using the term "floppy eyelid syndrome" and "lax eyelid syndrome" as the keywords in a PubMed search. Charts and cases were reviewed for the following information: age, sex, presence or absence of obesity, presence or absence of upper eyelid laxity, presence or absence of lower eyelid laxity, symmetry or asymmetry of eyelid laxity, sleeping position preference, diagnosis of obstructive sleep apnea (OSA), history of eye rubbing, diagnosis of keratoconus (KCN), lash ptosis, history of spontaneous eyelid eversion, papillary conjunctivitis, systemic hyperlaxity, diagnosis of meibomianitis, signs of anterior segment inflammation, and smoking or excessive sun exposure history. From our UNC case review, 14 patients involving 17 eyelids were identified. From the literature review, 72 articles were recovered and evaluated to yield a total of 324 reported cases through February 2007. From the combined data (n = 338), the overall minimum prevalence of sleep apnea in patients with lax eyelid condition was 16% compared with an estimated 9% to 24% in the general population. Of patients with lax eyelid syndrome, those identified with OSA had significantly more individuals with obesity (76% vs. 20%) and male gender (89% vs. 61%) than the group without OSA. The prevalence of KCN in patients with lax eyelid syndrome was a minimum of 6.8%, which is considerably higher than the estimated prevalence in the general population of 0.6%. However, KCN appears to show a significant association with the patient's side of sleeping preference. Eyelid laxity can result from a number of involutional, local, and systemic diseases but is frequently of unknown etiology. When it is consistently associated with papillary conjunctivitis and dry eyes it can be referred to as lax eyelid syndrome (LES). A number of specific subsets of LES can be identified. One such subset, occurring primarily though not exclusively in males and associated with obesity, has been defined as the floppy eyelid syndrome (FES). OSA has been associated with FES where it occurs with greater frequency than in the general population, but no greater than seen in obese males without FES, and therefore appears to represent an epiphonomenom only. However, given the demographics of FES, this condition offers some predictive value for OSA and should alert the physician to evaluate the sleep habits of all such patients. Keratoconus also shows some association with FES and with LES. However, data suggest that the causative factors are sleep preference for the involved side and nocturnal eyelid eversion, rather than any underlying physiologic or anatomic relationship.

Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: Randomized clinical trial

To compare the effects of fluidic parameters on the central corneal thickness (CCT), corneal endothelium, and anterior segment inflammation after phacoemulsification with longitudinal ultrasound. Iladevi Cataract & IOL Research Center, Ahmedabad, India. In this prospective randomized patient- and examiner-masked study, consecutive patients with age-related cataract were randomly assigned to Group 1 (low fluidic parameters: aspiration flow rate 25 cc/min; bottle height 70 cm and 90 cm; vacuum <or=400 mm Hg) or Group 2 (high fluidic parameters: aspiration flow rate 40 cc/min, bottle height 90 cm and 110 cm; vacuum <or=650 mm Hg). The rate of change in CCT and endothelial cell density (ECD), the incidence of anterior segment inflammation, and corneal clarity were compared between groups. The mean change in CCT from preoperatively to 1 day postoperatively was -6.49% +/- 2.7% in Group 1 and -13.44% +/- 4.3% in Group 2 and from preoperatively to 7 days, -1.74% +/- 1.3% microm and -5.55% +/- 4.3%, respectively (both P<.001). There was no statistically significant difference in the rate of change in ECD between groups from preoperatively to 3 months postoperatively (4.67% +/- 0.15% versus -5.22% +/- 2.84% (P = .45). Anterior chamber flare, cells, and corneal clarity at 1 day were significantly better in Group 1 than in Group 2. Low fluidic parameters led to a lower increase in CCT 1 day and 7 days postoperatively, decreased anterior segment inflammation at 1 day, and yielded clear corneas.

Corneal Endothelial Morphologic Features in Toxic Anterior Segment Syndrome

To investigate the clinical and laboratory findings of toxic anterior segment syndrome (TASS) following cataract surgery with intraocular lens (IOL) implantation, with emphasis on the morphologic features of the corneal endothelium. A single-center retrospective observational case-control design was used. The sample consisted of 15 patients (mean age 60.3 +/- 11.2 years) with a diagnosis of TASS following unilateral cataract surgery with IOL implantation. In all cases, cataract surgery with IOL implantation had already been performed in the fellow pseudophakic eye without complications. Data on the corneal endothelial morphologic features in both eyes were collected from the files as follows: endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells. Values in the eyes with TASS (study group) were compared with the fellow eyes (control group). Between-group differences were analyzed with Student's t test at a significance level of 5%. The eyes with TASS were characterized by a significantly lower endothelial cell density than the control eyes (2302 +/- 220 cells/mm vs. 2853 +/- 145 cells/mm), higher mean cell area (coefficient of variation; 38 +/- 1.4 vs. 24 +/- 2.5), and lower mean percentage of hexagonal cells (22 +/- 1.5% vs. 48 +/- 3.2%; P < 0.01 for all). Common presenting symptoms and signs were blurred vision (60%), anterior segment inflammation (100%), and cell deposition (20%). TASS following cataract surgery with intraocular lens implantation is associated with a low corneal endothelial cell density.

The peaks and valleys of ocular histoplasmosis syndrome

Ophthalmological examination of a 55-year-old white woman with longstanding ocular histoplasmosis syndrome (OHS) and recently diagnosed multiple sclerosis revealed poor central vision, peripapillary atrophy, extensive subretinal pigment deposition (figure), old choroidal neovascularisation (CNV; figure), and punched-out chorioretinal scars in the absence of any anterior segment and vitreous inflammation. Cirrus HD retinal optical coherence tomography (OCT) scan revealed markedly disrupted topography of the internal limiting membrane and retinal pigment epithelium layers resulting from extensive chorioretinal scarring (figure).

Drug-induced tubulointerstitial nephritis and uveitis syndrome with posterior uveitis resembling acute posterior multifocal placoid pigment epitheliopathy.

To report the occurrence of acute posterior multifocal placoid pigment epitheliopathy (APMPPE)-like posterior uveitis as part of the ocular manifestation of tubulointerstitial nephritis and uveitis (TINU) syndrome. A 54-year-old previously healthy woman received oral ibuprofen and dipirone because of high fever and malaise. Three days after being started on this treatment, she developed bilateral posterior uveitis resembling APMPPE accompanied by anterior segment inflammation in the context of acute renal nephritis and maculopapular skin rash probably related to drug exposure. The patient was hospitalized because of acute renal failure and received support therapy and topical steroids in both eyes. A renal biopsy was not performed (based on good clinical response), but she fulfilled the clinical criteria of acute interstitial nephritis and TINU. Although her renal and ocular functions improved in the first week, she needed to be readmitted days later because of fever and generalized edema and received steroid pulse therapy. Fluorescein angiography was consistent with an APMPPE-like pattern and optical coherence tomography showed neither macular edema nor subretinal fluid. The ocular picture improved during the following weeks with fundus changes resembling those of APMPPE. Although anterior uveitis is considered the typical ocular component of TINU syndrome, posterior uveitis resembling APMPPE may also be its ocular manifestation.

Plasmapheresis in the management of choroidal vasculitis associated with C-anca positive renal vasculitis.

The purpose of this study was to report the use of plasmapheresis in the management of choroidal vasculitis associated with Wegener granulomatosis. Case report. A 50-year-old woman with acute renal failure as a result of glomerulonephritis of the Wegener granulomatosis type presented with sudden visual loss. Visual acuities at presentation were counting fingers in the left eye and 6/24 in the right eye. Clinical examination showed significant choroidal ischemia with no evidence of vitritis or anterior segment inflammation. Fluorescein and indocyanine green angiography confirmed choroidal vasculitis. The patient was treated with a course of seven plasmapheresis sessions, after which she was maintained on prednisolone and mycophenolate. One week after her presentation, vision improved to 6/6 bilaterally. The angiographic appearances resolved, and the patient was maintained on immunosuppression. We believe that the prompt use of plasmapheresis prevented irreversible visual loss in this patient. This case illustrates the dramatic improvement in choroidal perfusion presumably resulting from the removal of a circulating immune factor.

A Comparative Study Between Diode Laser Cyclophotocoagulation and the Ahmed Glaucoma Valve Implant in Neovascular Glaucoma

To compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. A total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. Mean age of the patients was 60.0+/-11.7 years (range: 20 to 85) in the DCPC group and 57.2+/-10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4+/-11.9 mm Hg and 43.3+/-7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5+/-11.3 mm Hg and 22.09+/-7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. There was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

Impact of anterior capsule polishing on anterior capsule opacification after cataract surgery: a randomized clinical trial

To evaluate the effect of anterior capsule polishing on the development of anterior capsule opacification (ACO) in patients undergoing cataract surgery. This prospective randomized observational double-masked clinical trial comprised 120 eyes of 60 consecutive patients with bilateral age-related cataract who underwent phacoemulsification. The patients were randomly assigned to one of the two groups: One eye received a 360 degree anterior capsule polishing (group 1 (cases)) and the fellow eye was without anterior capsule polishing (group 2 (controls)) The primary observation was to observe the development of ACO between the 2 groups, whereas the secondary observation was to measure uveal inflammation. ACO was evaluated at 1 week, 1 month, and 6 months. At the 1-week follow-up, there was no significant difference in the development of ACO between the two groups. At 1 month, 54 (90%) eyes developed ACO in controls and 26 (43.3%) eyes in cases (P<0.001). However, at 6 months, there was no significant difference in the development of ACO between controls and cases (P=0.500). The odds of having cells and flare were significantly more in cases compared with controls at first postoperative day (cells: OR, 39.27; 95% CI, 13.49-114.26 and flare: OR, 48.0; 95% CI, 15.57-147.97). ACO was significantly lower at 1 month in cases compared with controls. However, the difference in ACO between the two groups was insignificant at 6 months. A significant difference in anterior segment inflammation was documented in cases on the first postoperative day. There was no detectable benefit of performing scraping on the anterior capsule to avoid opacification after phacoemulsification.E