Inflammation In Cataract Surgery Research Articles

Influence of Endogenous Substances on Site-II to Site-I Displacement of Diclofenac Bound to Albumin in the Aqueous Humor of Patients with Cataract.

Diclofenac instillation is useful in preventing intraoperative miosis and macular edema caused by postoperative inflammation in cataract surgery; however, optimum efficacy is not attained when the instilled diclofenac strongly binds to albumin in patients' aqueous humor. Therefore, a method that inhibits diclofenac binding and increases the concentration of its free fraction is needed. We conducted a basic study regarding the effects of inhibitors on the binding of instilled diclofenac to albumin and endogenous substances in aqueous humor. Aqueous humor samples from 16 patients were pooled together for analysis. The free fraction of diclofenac was measured using ultrafiltration methods in various experiments with pooled and mimic aqueous humor. Free fraction of diclofenac, a site II drug, in pooled aqueous humor was 0.363 ± 0.013. The binding of diclofenac in the presence of phenylbutazone (PB), a site I inhibitor, was significantly inhibited (free fraction = 0.496 ± 0.013); however, no significant inhibition by ibuprofen, a site II inhibitor, (free fraction = 0.379 ± 0.004), was observed. The unexpected result was due to free fatty acids (FFAs; palmitic acid (PA)) and L-tryptophan (Trp). The inhibition of diclofenac binding by PB in the mimic aqueous humor containing these endogenous substances revealed significant binding inhibition in the presence of PA and Trp. Diclofenac is strongly rebound from site II to site I in the presence of FFAs and Trp in the aqueous humor because FFAs and Trp induce a conformational change in albumin. Therefore, PB significantly inhibits the binding of diclofenac to albumin.

Comparison of topical and intracameral nonsteroidal anti-inflammatory drugs on pupillary size and postoperative inflammation in cataract surgery

Purpose The aim of this study was to compare the changes in pupillary size, postoperative inflammation, and macular thickness in patients who were subjected to phacoemulsification and received different topical and intracameral NSAIDs. Patients and methods This was a prospective randomized study that recruited 284 patients with visually significant cataract for whom uneventful phacoemulsification with intraocular lens implantation was performed. Candidates were randomly assigned to receive preoperative topical nepafenac, topical ketorolac, intraoperative intracameral ketorolac, or no NSAIDs. Results Topical nepafenac, topical ketorolac, and intracameral ketorolac had significantly maintained less intraoperative pupil size fluctuation than the placebo group (P=0.033, 0.001, and 0.048, respectively). In addition, topical nepafenac-treated, topical ketorolac-treated, and intracameral ketorolac-treated groups had less postoperative anterior chamber cells than the placebo group at 1 day (P=0.019, 0.421, and 0.515, respectively) and at 1 week, postoperatively (P=0.037, 0.089, and 0.298, respectively). However, at 1 month postoperatively, all study groups had similar minimal anterior chamber reaction with an insignificant difference (P=0.237, 0.379, and 0.342, respectively). Retinal thickness increased in all study groups 1 month after cataract surgery. However, topical and intracameral ketorolac groups had significantly less central macular thickness change as compared with the placebo (P=0.009 and 0.004, respectively). Conclusion The use of topical or intracameral NSAIDs yielded less intraoperative fluctuation in pupil size and lower postoperative inflammation than the placebo group. The topical nepafenac group had less postoperative inflammation, whereas the ketorolac-treated patients had the least changes in retinal thickness.

Comparison Between Topical Nepafenac and Flurbiprofen in Maintaining Intraoperative Mydriasis and Controlling Postoperative Inflammation in Cataract Surgery

Background: Preoperative dilation of pupil is one of the prerequisistes to perform an uncomplicated cataract surgery. Intraoperative miosis is one of the many challenges which a surgeon can encounter during cataract surgery. Preoperative use of NSAIDS like nepefenac, flurbiprofen, ketorolac have been used for maintaining intra operative mydriasis and controlling postoperative inflammation by blocking prostaglandin synthesis. Aims: To compare the efficacy of nepafenac and flurbiprofen in maintaining intraoperative mydriasis and controlling postoperative inflammation Settings and Design: This was an institutional prospective comparative study done in rural Karnataka. Methods and Material: This study was performed on 110 patients, 55 were allocated in each group and were given either of the topical NSAID’s Nepafenac or Flurbiprofen prior to cataract surgery. Pupillary diameter was measured at the beginning and at the end of the surgery and the values were compared between the groups. Postoperative inflammation was also compared between both the groups. Statistical analysis used: The difference in flare and cells grading across groups were tested using Chi-Square test. p value of < 0.05 was considered statistically significant Results: The mean pupillary diameter of the two groups were comparable at the beginning of surgery The mean change in the pupillary diameter was more in flurbiprofen group when compared to nepafenac group. There was statistically significant difference among both the groups in maintenance of intraoperative mydriasis .The comparison of postoperative inflammation was also statistically different between both the groups. Conclusions: Pre-operative Nepafenac was found to be better than flurbiprofen in maintaining intraoperative mydriasis and controlling postoperative inflammation. Keywords: Cataract surgery, Surgical miosis, NSAIDs, Nepafenac, Flurbiprofen

Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery.

To report the effectiveness of intravitreal implantation of dexamethasone implant (Ozurdex) after phacoemulsification and intraocular lens implantation in refractory uveitis patients. This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation. The main outcome measurements were best-corrected visual acuity (BCVA), central retinal thickness (CRT), grade of anterior chamber cell (AAC), intraocular pressure (IOP), and systemic/ocular adverse events. Ten eyes of 7 patients were included. BCVA showed significant improvement at 1mo (P=0.004), 3mo (P=0.0004), and 6mo (P=0.001) post operation. There were no statistically significant differences in the postoperative CRT among follow-up groups (P>0.05). No significant differences were observed in the baseline IOP when compared to 1, 3, and 6mo (all P>0.05) post operation. One patient developed a transient elevated IOP post injection. Two eyes (20%) developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In six patients (8 eyes, 71.4%), the systemic steroid usage was reduced to below 10 mg/d. The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6mo before operation and 0.7±0.48 in the 6mon post operation. The mean recurrence time was 13±0.58wk (range 12-14wk) post operation. In five of seven patients (7 out of 10 eyes), inflammation relapse was developed postoperatively. Only one patient (2 eyes) needed increased amounts of oral corticosteroids. Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids. Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study. After the disappearance of Ozurdex's anti-inflammatory effects over time, in most cases the recurrent inflammation can be controlled by topical steroids.

Efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation in cataract surgery

Background:A cataract is a degenerative change in the optical quality of the lens caused by protein denaturation. Modern medicine is mainly based on surgical treatment. Cataract surgery is often accompanied by severe inflammation, and glucocorticoid therapy has many adverse reactions and side effects. The non-steroidal anti-inflammatory drug sodium bromfenac not only has good anti-inflammatory, analgesic and anti-allergic effects, but also does not produce side effects caused by hormone drugs. Clinical studies have shown that sodium bromfenac eye drops have a good curative effect in treating postoperative inflammation of cataract, with low recurrence rate and certain therapeutic advantages, but lack of evidence-based medicine evidence. The purpose of this study is to systematically evaluate the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataracts.Methods:Use computer to search English and Chinese databases, such as PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, Weipu, China Biomedical Database, and Chinese Clinical Trial Registry for randomized controlled trials on the treatment of postoperative postoperative inflammation in cataract surgery with sodium bromfenac eye drops from the establishment of the database to September 2020, and data extraction and literature quality evaluation were conducted independently by two researchers, and Meta analysis was conducted on the included literature using RevMan5.3 software.Results:In this study, the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataract surgery were evaluated by the effective rate, symptom score, adverse reactions, incidence, recurrence rate, etc.Conclusion:This study will provide reliable evidence-based evidence for the clinical application of bromofenac sodium eye drops in the treatment of postoperative inflammation of cataract.OSF Registration number:DOI 10.17605/OSF.IO/3KP7R

The importance of preoperative topical non-steroidal antiinflammatory agents in cataract surgery- an open label prospective randomised comparative study

Introduction: Intraoperative miosis is a problem which can lead to various complications that may adversely affect the outcome of cataract surgery. Topical non-steroidal anti-inflammatory drugs (NSAIDs) have been found to be helpful in reducing the intraoperative miosis. We tried to compare the effectiveness of two such molecules bromfenac and nepafenac. Objective: To compare the effectiveness of topical bromfenac (0.09%) and nepafenac (0.1%) in maintaining mydriasis and controlling immediate post-operative inflammation in cataract surgery. Methods: This is a prospective, randomised, open-label, comparative study of patients with senile cataract posted for cataract extraction and intra-ocular lens (IOL) implantation. The patients were randomised into 3 groups: topical moxifloxacilin 0.5% alone (control group or group A), topical bromfenac 0.09% + moxifloxacilin 0.5% (group B) and topical nepafenac 0.1% + moxifloxacilin 0.5% (group C). The drops were started one day before surgery. Mean pupil diameter was measured before starting surgery and after implanting IOL. Slit lamp examination was done on first postoperative day to look for anterior chamber reaction. The values were compared among the 3 groups. Results: The total loss of mean pupillary diameter was significant (p &lt; 0.0001) in control group (25.87%) as compared to bromfenac (3.51%) and nepafenac (3.81%) group. Post-operative inflammation was significantly less (p &lt;0.0001) in bromfenac and nepafenac group as compared to that of control group. Loss of mydriasis and post-operative inflammation was similar in both bromfenac and nepafenac group. Conclusion: Both bromfenac and nepafenac given topically prior to cataract surgery are equally effective in maintaining mydriasis during surgery as well as in controlling immediate postoperative inflammation.

Efficacy and safety of bromfenac 0.075% formulated in DuraSite for pain and inflammation in cataract surgery

ABSTRACTIntroduction: Bromfenac is a topical ophthalmic non-steroidal anti-inflammatory drug (NSAID) used to reduce pain and treat post-operative inflammation after cataract surgery. Bromfenac 0.075% in the DuraSite™ vehicle is a newly-approved formulation which has been shown to be efficacious and safe for use in cataract surgery to reduce pain and treat inflammation. It has been shown to have a slightly better posterior segment ocular bioavailability compared to similar topical ophthalmic NSAIDs. However, there is a paucity of studies investigating its role in the prevention and treatment of post-operative pseudophakic cystoid macular edema.Areas covered: In this review, the authors provide an overview of similar products available, describe the novelty of bromfenac 0.075% in the DuraSite vehicle, and discuss the relevant clinical studies to determine if the formulation is safe and efficacious.Expert opinion: Bromfenac 0.075% in the DuraSite vehicle is a new topical ophthalmic medication which has been approved by the FDA for the prevention of pain and treatment of post-operative inflammation. It provides cataract surgeons with an additional medication for cataract surgery. However, no robust studies have been performed showing the effect that it has on the reduction or prevention of post-operative pseudophakic cystoid macular edema.

To Study the Efficacy of Difluprednate Ophthalmic Emulsion and Prednisolone Acetate Ophthalmic Suspension on Post-operative Inflammation in Cataract Surgery.

Senile cataract is the most common cause of visual impairment. Removal of cataract and implantation of intraocular lens implantation (IOL) is the main surgical approach for cataract. The major block in quick visual rehabilitation of the patient is post-operative inflammation. To limit post-operative inflammation corticosteroids drugs are used in routine prophylactically. Topical prednisolone acetate 1% and betamethasone 0.1% remain gold standard to control post-operative inflammation but newer drugs like difluprednate, loteprednol are also effective in controlling inflammation. To study the efficacy of difluprednate ophthalmic emulsion and prednisolone acetate ophthalmic suspension on Post-operative inflammation in cataract surgery (clear corneal phacoemulsification with foldable IOL). This study was carried out on 100 patients having visually significant cataract requiring surgery, clear corneal phacoemulsification with foldable intraocular lens implantation was done in all patients. Patients were randomly divided into two groups. In group A topical 1% prednisolone acetate ophthalmic suspension was administered six times a day Post-operatively. In group B 0.05% difluprednate ophthalmic emulsion was administered six times a day post-operatively. Efficacy of drug was evaluated in terms of decrease in ocular pain, anterior chamber reaction in the form of aqueous cells and flare and final visual acuity at 4 weeks. In this study, 92% of patients in group A and 90% of patients in group B had BCVA 6/6. None of the patients in group A had ocular pain. In group B, 96% patients had no ocular pain. Remaining 4% had mild discomfort but required no medication. 98% of patients in group A and 100% of patients in group B presented with clearance of aqueous cells at the end of study. Only 2% of patients in group A had showed cell score (±). Though prednisolone acetate has been the gold standard anti inflammatory agent, 0.05% Difluprednate ophthalmic emulsion is equally effective in treatment of post-operative inflammation. Difluprednate have added an advantage of uniform drug dosage and absence of harmful preservative.

Femtosecond Laser-Induced Macular Changes and Anterior Segment Inflammation in Cataract Surgery

To compare femtosecond laser-assisted cataract surgery with standard phacoemulsification concerning the incidence of postoperative clinical or subclinical macular edema and the correlation between macular thickness and postoperative intraocular inflammation values. One hundred four eyes of 104 patients were treated by laser-assisted cataract surgery and the fellow 104 eyes underwent phacoemulsification using pulsed ultrasound energy and intraocular lens implantation in this prospective randomized study. Laser flare photometry was measured preoperatively and at 2 hours, 3 to 4 days, 1 month, 3 months, and 6 months postoperatively. Retinal thickness was measured by spectral-domain optical coherence tomography. Two hundred two eyes (97%) were included and analyzed at 6 months postoperatively. The mean center thickness in the laser group was 210 ± 24 μm at 4 days postoperatively, 214 ± 22 μm at 1 month postoperatively, 219 ± 20 μm at 3 months postoperatively, and 215 ± 22 μm at 6 months postoperatively. The mean center thickness in the standard group was 211 ± 32 μm at 4 days postoperatively, 210 ± 34 μm at 1 month postoperatively, 217 ± 29 μm at 3 months postoperatively, and 209 ± 30 μm at 6 months postoperatively. Laser flare photometry showed higher levels in the standard group at the first postoperative visit 2 hours after surgery compared with the laser group. Femtosecond laser-assisted cataract surgery did not obviously influence the incidence of postoperative macular edema.

This issue of Acta

The cover illustration on this edition of Acta shows optical coherence tomography images before and after sheathotomy, as demonstrated by Crafoord et al. later in these pages. This issue of Acta contains three editorials. In one of these, Sven Crafoord, in Örebro, discusses the use of small-gauge instruments in vitrectomy, with reference to three articles on the use of 25-gauge instrumentation in vitrectomy that appear later in the journal. Einar Stefánsson explains the pathophysiology of branch retinal vein occlusion and its treatment and puts sheathotomy, vitrectomy, laser, anti-VEGF drugs and intravitreal steroids into context, and Buys et al. celebrate World Glaucoma Day in a guest editorial. Wang and associates, writing from Copenhagen and Basel, present a comprehensive review of central serous chorioretinopathy. Crafoord et al.’s paper on sheathotomy − discussed in Stefánsson’s editorial − describes a retrospective study of the technique as a treatment for branch retinal vein occlusion. Tokyo-based Shinoda et al. found visual recovery to be quicker in vitrectomy patients operated with 25-gauge instrumentation than in those in whom 20-gauge instruments were used. They found no difference between the groups at 1 year after surgery. Magalhaes et al., writing from São Paulo, found that infusion and aspiration rates varied between three different 25-gauge vitrectomy systems. In a further paper, Shinoda et al. point out that 25-gauge vitrectomy instruments may become jammed in the cannula in eyes with non-clearing vitreous haemorrhage. Yeung et al., of Taiwan, found a negative association between the severity of vitreous haemorrhage and visual outcome in rhegmatogenous retinal detachments. A severe vitreous haemorrhage increases the risk of proliferative vitreoretinopathy in these patients. Swedish authors Bengtsson et al. suggest that standard automated perimetry and short-wavelength automated perimetry may be useful for monitoring visual function outside the fovea in patients with diabetic retinopathy. German researchers Neubauer et al. compare two different camera systems for screening and grading of diabetic retinopathy. Yeh et al., based in Taiwan, present three patients successfully treated with vitrectomy without inner limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes. Jonas et al., writing from Germany, describe the successful injection of autologous bone marrow mononuclear cells into the vitreous cavity in a diabetes patient. UK authors Ugarte et al. present a case of hypertensive choroidopathy, furnished with comprehensive illustrations. Karalezly, writing from Ankara, report on using intracameral triamcinolone acetonide to control postoperative inflammation in cataract surgery. Stockholm-based Mody et al. studied cataract formation induced by ultraviolet radiation in guinea-pigs. They found that ascorbate supplementation did not reduce the risk of cataract formation in this model. In an inter-country collaboration between Canada and France, Tournier et al. describe their findings that visual impairment is associated with an increased risk of depression in elderly subjects, as well as an increased risk of death. UK authors Miranda and Henson, based in Manchester, found that patients respond better to multiple-stimulus perimetry with verbal feedback than they do to single-stimulus automated perimetry. Meanwhile, London-based Bergin et al. report on a new algorithm for the analysis of Heidelberg retina tomograph images. Kirwan and O’Keefe, in Dublin, describe corneal hysteresis following LASIK and LASEK. Hysteresis did not correlate with the amount of corneal tissue removed, the size of the optical zone nor the patient’s age. We launch a new feature in this issue of Acta. Stockholm’s Professor Stefan Seregard is interviewed by Gunilla Magnusson. We hope to carry interviews and news items on a regular basis in this section. We also include a list of forthcoming conferences and courses. Readers of Acta are invited to notify the editorial office of conferences and courses they would like to see listed in the journal. I hope that this issue of Acta serves as a source of both pleasure and knowledge to its readers.

Inflammation in cataract surgery

Cataract surgery induces rupture of the blood–ocular barrier. Topical corticosteroids or NSAIDs have been demonstrated to be effective in the management of postoperative inflammation after cataract surgery. Endophthalmitis, toxic anterior segment syndrome or retained intraocular lens material may be responsible for increased postoperative inflammation. The choice of a less traumatic phacoemulsification technique, small incision, adequate infusion solution and implantation in the bag, may reduce postoperative inflammation. In severe uveitis, adequate control of inflammation should be achieved for at least 3 months and surgery should be performed when intraocular inflammation is brought under control, using systemic corticosteroids or immunosuppressive therapy as needed. In the presence of decreased visual acuity postoperatively, cystoid macular edema should be ruled out clinically, by either optical coherence tomography or fluorescein angiography. The recent development of biopolymers as drug-delivery systems has shown their efficacy in the management of intraocular inflammation after cataract surgery.

Acular as a single agent for use as an antimiotic and anti-inflammatory in cataract surgery

Purpose To assess the safety and effectiveness of ketorolac tromethamine 0.5% (Acular®) as a cost-efficient single agent to prevent intraoperative miosis and postoperative inflammation in cataract surgery. Methods Both eyes of 26 patients were randomized to receive Acular preoperatively and postoperatively or flurbiprofen sodium (Ocufen®) preoperatively and prednisolone acetate 1% (Pred Forte®) postoperatively. Time scheduled between procedures was from 2 weeks to 1 month. Pupil dilation was measured preoperatively, intraoperatively, and at the end of surgery. Cell and flare were measured 1 day, 1 week, and 1 month postoperatively. Results A comparison of the Acular and the Ocufen/Pred Forte groups (n=22) showed no statistically significant differences in dilation (preoperative versus postpostoperative) or cell and flare postoperatively. Conclusion Using Acular as a single agent was as effective as the combination of preoperative Ocufen and postoperative Pred Forte in preventing intraoperative miosis and postoperative inflammation in cataract surgery. The use of Acular as a single agent could save the expense of using separate anti-inflammatory and antimiotic preparations preoperatively and postoperatively, enhancing convenience for the surgeon and surgical facility.