Preexisting Ocular Disease Research Articles

Preservatives in eyedrops: The good, the bad and the ugly

There is a large body of evidence from experimental and clinical studies showing that the long-term use of topical drugs may induce ocular surface changes, causing ocular discomfort, tear film instability, conjunctival inflammation, subconjunctival fibrosis, epithelial apoptosis, corneal surface impairment, and the potential risk of failure for further glaucoma surgery. Subclinical inflammation has also been described in patients receiving antiglaucoma treatments for long periods of time. However, the mechanisms involved, i.e., allergic, toxic, or inflammatory, as well as the respective roles of the active compound and the preservative in inducing the toxic and/or proinflammatory effects of ophthalmic solutions, is still being debated. The most frequently used preservative, benzalkonium chloride (BAK), has consistently demonstrated its toxic effects in laboratory, experimental, and clinical studies. As a quaternary ammonium, this compound has been shown to cause tear film instability, loss of goblet cells, conjunctival squamous metaplasia and apoptosis, disruption of the corneal epithelium barrier, and damage to deeper ocular tissues. The mechanisms causing these effects have not been fully elucidated, although the involvement of immunoinflammatory reactions with the release of proinflammatory cytokines, apoptosis, oxidative stress, as well as direct interactions with the lipid components of the tear film and cell membranes have been well established. Preservative-induced adverse effects are therefore far from being restricted to only allergic reactions, and side effects are often very difficult to identify because they mostly occur in a delayed or poorly specific manner. Care should therefore be taken to avoid the long-term use of preservatives, otherwise a less toxic alternative to BAK should be developed, as this weakly allergenic but highly toxic compound exerts dose- and time-dependent effects. On the basis of all these experimental and clinical reports, it would be advisable to use benzalkonium-free solutions whenever possible, especially in patients with the greatest exposure to high doses or prolonged treatments, in those suffering from preexisting or concomitant ocular surface diseases, and those experiencing side effects related to the ocular surface. Indeed, mild symptoms should not be underestimated, neglected, or denied, because they may very well be the apparent manifestations of more severe, potentially threatening subclinical reactions that may later cause major concerns.

Atteinte oculaire et environnement : clinique et physiopathologie

Environment has an important impact on the ocular surface. The frequency of ocular symptoms in some buildings can rise up to 40%. Personal background plays a major role: women and patients with medical history of allergic conjunctivitis or all other chronic conjunctivitis are more sensitive. Etiological factors are numerous: interior or exterior, physical, particular, chemical or biological. The diagnosis of an environmental ocular disease is often difficult. Except in allergy, symptoms are those of a non-specific irritation. Tear film instability with decreased tear break-up time is the most frequent clinical sign, which is also nonspecific. Conjunctival hyperaemia is also frequent, whereas Schirmer and vital staining testings are normal. Neutrophils, eosinophils and non-specific inflammatory markers can be found locally. Treatment relies on environmental control, treatment of a preexisting ocular disease, artificial tears and sometimes anti-inflammatory eyedrops. A close cooperation between ophthalmologists, allergologists and hygienists is mandatory.

Visual Rehabilitation Rate After Isolated Descemet Membrane Transplantation

To evaluate visual rehabilitation after Descemet membrane endothelial keratoplasty (DMEK) in the management of corneal endothelial disorders. In this prospective, nonrandomized, clinical study, DMEK was performed in a first group of 35 consecutive patients with either Fuchs endothelial dystrophy or bullous keratopathy. The Descemet membrane was stripped from the recipient posterior stroma with the anterior chamber completely filled with air. Using a 3.0-mm clear corneal incision, an organ-cultured donor Descemet roll 9 to 10 mm in diameter was inserted into the recipient anterior chamber, positioned on the posterior stroma, and secured by completely filling the anterior chamber with air for 45 to 60 minutes. Ten eyes had preexisting ocular disease or an early graft detachment. In the remaining 25 DMEK-treated eyes, best-corrected visual acuity was 20/40 (Snellen notation, 0.5) or more in 18 eyes (72%) within 1 month. At 3 months, best-corrected visual acuity was 20/40 (0.5) or more in 23 of 25 eyes (92%) and 20/25 (0.8) or more in 15 of 25 eyes (60%). In most cases, DMEK results in functional visual rehabilitation within 1 to 3 months. Overall, visual recovery after DMEK may be faster and more complete than with other techniques for (lamellar) keratoplasty for treatment of corneal endothelial disorders. clinicaltrials.gov Identifier: NCT00521898.

Corneal bacterial diseases

Abstract Purpose To present the main causes of corneal bacterial diseases and suggest an appropriate management. Bacterial keratitis is the most common cause of infected corneal ulceration. Methods The epidemiology of corneal bacterial diseases and their link with different risk factors will be studied. The initial presentation is important to determine the potential stain responsible for the infection and to assess the overall severity of the disease. Local and general criteria evaluations lead to a proper management. Bacterial identification plays a key‐role in the etiological diagnosis. Results Contact lens wear, trauma, preexisting ocular disease and corneal surgery are the main risk factors for corneal bacterial disease. Specific signs to identify bacteria remain rare but the circumstances (contact lens wear, aspect of the infiltrate) can help to determine the first line treatment. However laboratory methods remain the only way to diagnose a corneal bacterial disease with certainty. The aspect of the infiltrate, the intraocular involvement and an immunosuppressed patient may influence the outcome. The treatment is based on an initial broad‐spectrum antibacterial therapy with secondary adaptation to the identified bacteria. Conclusion Multiple microorganisms are involved in corneal diseases. The local and systemic risk factors have to be identified to treat these diseases in emergency still considered as a leading cause of visual loss.

Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated with nepafenac

To compare the incidence of visually significant pseudophakic macular edema after uneventful phacoemulsification in patients treated postoperatively with topical prednisolone and those treated with topical prednisolone and nepafenac 0.1% suspension (Nevanac). Edward S. Harkness Eye Institute of Columbia University, New York, New York, USA. This retrospective chart review was of consecutive patients who had phacoemulsification at a single institute and were given topical prednisolone alone or topical prednisolone and nepafenac to prevent cystoid macular edema. Data collection included preexisting ocular and systemic diseases, concurrent use of ocular and systemic medications, surgical technique, intraoperative and postoperative complications, follow-up visual and ocular assessments, and postoperative optical coherence tomography (OCT) assessment for macular edema. Postoperatively, 240 patients were treated with prednisolone and 210 patients, with prednisolone-nepafenac. Preoperatively, the 2 groups were demographically and clinically comparable in sex distribution (P = .8400), history of diabetes (P = .7267), hypertension or cardiac disease (P = .8690), and concurrent use of oral nonsteroidal anti-inflammatory drugs (P = .7303). Iris manipulation was done in 16 patients in the prednisolone-alone group and 10 patients in the prednisolone-nepafenac group (P = .3876). Capsule staining was done in 5 patients and 4 patients, respectively. All patients were followed for at least 1 month postoperatively. Visually significant pseudophakic macular edema was documented by OCT in 5 patients treated with prednisolone alone and in no patients treated with prednisolone and nepafenac (P = .0354). No significant intraoperative or postoperative complications were reported. Patients treated with topical prednisolone alone had a significantly higher incidence of visually significant pseudophakic macular edema after uneventful cataract surgery than those treated with topical prednisolone and nepafenac.

Microbial Keratitis Pathogens and Antibiotic Susceptibilities: A 5-Year Review of Cases at an Urban County Hospital in North Texas

To review the epidemiology, risk factors, microbiologic spectrum, and outcomes of microbial keratitis and to compare cases in which a causative organism is identified to those determined to be sterile during a 5-year period at a large county hospital in north Texas. A retrospective chart review of cases of microbial keratitis at Parkland Memorial Hospital between January 2000 and December 2004. During this 5-year period, 132 eyes of 131 patients underwent 139 corneal scrapings for presumed microbial keratitis and an organism was reported in 73 (52.5%) cultures. Including abnormal confocal microscopy results, a causative organism was determined in 78 (56.1%) cases. At least one risk factor was present in 115 (87.1%) cases, with the most common risk factors being preexisting ocular disease, contact lens wear, and a history of trauma. Nearly 5% of patients reported a history of cocaine use. Gram staining correctly identified the organism in 20 (28.6%) culture-positive cases, and Pseudomonas aeruginosa was the most common isolate, followed by Staphylococcus aureus. The rate of S. aureus resistance to fluoroquinolones (15.4%) was similar to rates previously reported from the early to mid 1990s, but less than those reported from the late 1990s. Severe complications were more common in the nonsterile subgroup (34.2%) than in the sterile (16.9%) subgroup (P=0.041). Although the rate of acute intervention was higher in the nonsterile subgroup (27.4%) than in the sterile subgroup (20.3%), this difference was not statistically significant (P=0.461). Mean logMAR visual acuity was 1.451 (Snellen equivalent, 20/563) at presentation and 1.062 (20/231) at the last follow-up visit (P<0.001). Presenting and final visual acuities were significantly better in the sterile subgroup than in the nonsterile subgroup (P<0.001 and P=0.002, respectively). When a causative organism is not identified in microbial keratitis, visual acuity is not as severely affected, and fewer severe complications occur. Antibiotic resistance to fluoroquinolones and aminoglycosides, though not common, still deserves consideration in the treatment of microbial keratitis.

Ocular disease in pregnancy

Pregnancy may cause ocular changes, both physiologic and pathologic, and may be associated with the development of new disease or may alter the course of preexisting disease. This paper discusses these changes and reviews diabetic retinopathy, uveitis, preeclampsia, cortical blindness and central serous chorioretinopathy. Recent reports have contributed to our understanding of the pathophysiology of diabetic retinopathy and cortical blindness associated with preeclampsia, the impact of pregnancy on the course of inflammatory eye disease, and the use of optical coherence tomography in following central serous chorioretinopathy in pregnant women. This improved understanding of the pathophysiology of ocular disease in pregnancy and the impact of pregnancy on the course of preexisting ocular disease offers the opportunity for meaningful counseling of women who are pregnant or planning to become pregnant.

Ethambutol Ocular Toxicity in Treatment Regimens for Mycobacterium avium Complex Lung Disease

Ethambutol (EMB) is an important component of multidrug treatment regimens for Mycobacterium avium complex lung disease. Ocular toxicity is the most important potential EMB toxicity, especially in the elderly population with M. avium complex lung disease. Two hundred twenty-nine patients with M. avium complex lung disease, 55% women and 53% with nodular/bronchiectatic disease, received a mean of 16.1 +/- 10.8 months of multidrug therapy that included EMB. Fifty patients (22%) were known to have preexisting ocular disease. While on EMB, 97 (42%) patients consulted an opthalmologist and 24 (10%) stopped EMB at least temporarily. Eight of 139 patients (6%) on daily therapy were diagnosed with EMB ocular toxicity, whereas 0 of 90 patients on intermittent therapy had EMB ocular toxicity (p = 0.05). All patients with EMB ocular toxicity developed symptoms between outpatient clinic appointments; none were diagnosed with routine visual acuity and color vision testing. All patients with EMB ocular disease returned to baseline ocular status after discontinuation of EMB. Intermittent EBM administration was associated with less ocular toxicity than daily EMB administration in this patient population.

Unusual reaction to fluorescein dye in patients with inflammatory eye disease.

Ocular side effects attributable to intravenous fluorescein dye are not well characterized. The purpose of this report was to describe three patients with an unusual ocular reaction after the intravenous administration of fluorescein dye. Retrospective review of the clinical and photographic records of three patients. Each patient had some type of preexisting ocular inflammatory disease. Each patient described the subacute onset of a unilateral burning sensation and tearing several minutes after the administration of intravenous fluorescein dye. Findings included a new onset of or a worsening of unilateral conjunctival chemosis and injection in all three patients and yellowish discoloration of the conjunctiva in two patients. In each patient, the noninflamed (fellow) eye did not develop any symptoms or show any visible reaction. The symptoms and findings resolved promptly in the affected eye without specific treatment or effect on vision. Ocular side effects of intravenous fluorescein dye can include transient symptomatic burning and tearing associated with conjunctival chemosis, injection, and yellowish discoloration. Eyes with active inflammatory diseases may be predisposed to this rare effect through an unclear mechanism.

Patient satisfaction in our initial experience with endonasal endoscopic non-laser dacryocystorhinostomy

background/aims Endonasal endoscopic dacryocystorhinostomy (EN-DCR) is now a well-established procedure to relieve nasolacrimal duct obstruction. In the past, attempts have been made to comment on the anatomical success of the procedure. However, no studies have been conducted to evaluate patient satisfaction with the EN non-laser DCR procedure in comparison with the surgeon's experience. methods Records of patients undergoing EN-DCR and external DCR (ET-DCR) surgery were reviewed. A telephone questionnaire was used to assess patient satisfaction with both procedures. Data were analyzed with Fisher's exact test and the chi-square test. results Twenty primary EN-DCR's and 16 revision EN-DCR's were performed by the same surgeon (RM) over a three-year period. At last review, 89% of ET-DCR and 75% of EN-DCR procedures were noted to have a patent sac washout performed in the eye clinic. A telephonic interview revealed no significant difference between the surgical outcome [15/20 (75%)] and patient satisfaction [14/20 (70%)] with the primary EN-DCR procedure. Patient satisfaction with revision EN-DCR [10/16 (63%)] was slightly poorer than the surgical outcome recorded for revision EN-DCR [12/16 (75%)] but this was also not statistically significant. Telephonic interview was possible for 42/64 (66%) patients undergoing primary external ET-DCR's and a total of 36/42 (86%) patients were satisfied with the procedure. Patient age, laterality, duration of symptoms, previous ocular procedures or preexisting ocular disease and associated ENT procedures did not alter the surgical result or patient satisfaction in either group. conclusions This study suggests that patient satisfaction with endoscopic endonasal non-laser DCR for primary or revision DCR surgery is comparable to that with the external-DCR technique since there was no significant difference in patient satisfaction between the two groups of patients. Patient perception of their symptomatic improvement was lower (though not statistically significant) in relation to the final clinical assessment of the outcome of both primary and revision EN-DCR.

Visual Function, Quality of Life and Patient Satisfaction after Ophthalmic Surgery: A Comparative Study

Purpose: To compare visual acuity, functional visual performance (VF-14), quality of life (QOL) gain (VF-14 gain) and patient satisfaction in a series of patients undergoing common types of ophthalmic surgery. Method: In a prospective trial, the VF-14 QOL questionnaire was administered to 100 patients who underwent surgery by one surgeon between May 2001 and April 2002. The following surgeries were compared: (1) cataract surgery (non-diabetic patients), (2) cataract surgery (diabetic patients), (3) retinal detachment cryo-buckle procedure, (4) pars plana vitrectomy, (5) silicone oil removal. VF-14 questionnaire responses, visual function and clinical data of all patients were recorded pre-operatively and 1 and 3 months postoperatively. Results: In comparison to vitreoretinal surgery, patients who underwent cataract surgery achieved higher VF-14 scores and required less time to recover from the procedure (1 month). The QOL gain (VF-14 gain) was significantly higher in patients who had undergone retinal detachment surgery and vitrectomy (p < 0.0001). The lowest QOL gain was registered in diabetic patients after cataract surgery. Patients with pre-existing eye disease, including patients with improved visual acuity, were least satisfied with the final outcome of surgery. Conclusions: The highest VF-14 score was achieved by patients with no pre-existing ocular disease, who had undergone cataract surgery. The QOL gain was greater in patients with severer initial ocular conditions. Better patient satisfaction can be achieved in patients with pre-existing eye disease by improving pre-operative patient education.

Indications for and outcomes of penetrating keratoplasty performed by resident surgeons

PurposeTo analyze the indications for and outcomes of penetrating keratoplasty (PKP) performed by resident surgeons at both county hospital and Veterans Affairs facilities. DesignObservational case series MethodsRetrospective review of 79 eyes from 61 patients undergoing PKP from January 1, 1997, through December 31, 2001, to determine indications for surgery and outcomes, including graft clarity and final visual acuity. ResultsThere were 52 (65.8%) primary and 27 (34.2%) repeat transplants performed. Follow-up after surgery averaged 21.9 months. Indications for PKP included failed graft, 23 (29.1%), bullous keratopathy, 17 (21.5%), keratoconus, 16 (20.3%), corneal scar, 15 (19.0%), corneal perforation from infection, 5 (6.3%), and Fuchs endothelial dystrophy, 3 (3.8%). Twenty-one eyes had pre-existing ocular disease limiting final acuity. Overall, 51 grafts (64.6%) remained clear. More primary than repeat grafts remained clear (75% vs 44.4%, P = .012) and achieved 20/40 or better final acuity (30.8% vs 11.8%, P = .05). Excluding failed grafts or eyes with limited visual potential, final acuities achieved were: 19 (47.5%) 20/40 or better, 18 (45%) 20/50 to 20/150, 3 (7.5%) 20/200 or worse. Grafts remaining clear by indication were: failed graft, 9 (39.1%); keratoconus, 14 (87.5%); bullous keratopathy, 13 (76.5%); corneal scar, 10 (66.7%); corneal perforation, 2 (40%); Fuchs, 3 (100%). Eyes achieving final acuity of 20/40 or better by indication were: keratoconus, 9 (56.2%); failed graft, 3 (13%); bullous keratopathy, 3 (17.7%); corneal scar, 2 (13.3%); corneal perforation, 0 (0%); Fuchs, 2 (66.7%). ConclusionsCounty hospital and Veterans Affairs facilities provide a challenging subset of patients for penetrating keratoplasty. Failed graft was the leading indication for transplantation for our population. Graft clarity and final visual acuity varied by indication for transplantation. Resident surgeons can achieve favorable results for penetrating keratoplasty performed at these venues, especially for primary transplants.

Advances in topical glaucoma therapy

Significant advances have recently been achieved in the development of topical glaucoma medications. The primary advantage of a topical preparation is the reduced incidence of adverse systemic effects attributable to a given drug compared to its systemically administered counterpart. However, the strong protective barrier of the eye forces topical ophthalmic preparations to be highly concentrated and in some cases, they have the potential to produce unwanted systemic effects, particularly in smaller animals. Oral carbonic anhydrase inhibitors are commonly associated with adverse effects in both humans and animals. Two recently developed topical carbonic anhydrase inhibitors, dorzolamide and brinzolamide, have shown promise in reducing intraocular pressure in animals and systemic side effects are apparently limited with their use. The topical alpha2-agonist apraclonidine, on the other hand, effectively reduces intraocular pressure in cats and dogs, but in its currently available form is likely to induce unwanted systemic effects. Latanoprost is a topical prostaglandin F2alpha analog that has proven effective in reducing intraocular pressure in dogs and horses, but while systemic side effects have not yet been reported, this topical preparation may exacerbate pre-existing or concurrent ocular inflammatory disease.

Mexiletine and persistent ophthalmic changes.

Mexilitine is an anti-arrhythmic agent used to treat neuropathic pain. The drug has a low side-effect profile with gastritis as the predominant complaint. The following two cases suggest that mexilitine can potentially cause persistent ophthalmic changes and should be used with caution in chronic pain patients with preexisting ocular disease.

Making Sense of Refractive Surgery in 2001: Why, When, for Whom, and by Whom?

Making Sense of Refractive Surgery in 2001: Why, When, for Whom, and by Whom?

Microbial Keratitis Resulting in Loss of the Eye

The purpose of this study was to determine the clinical characteristics of infected corneal ulcers resulting in loss of the eye. The authors conducted a retrospective study of all cases requiring evisceration or enucleation due to microbial keratitis at Wills Eye Hospital between January 1, 1989, and December 31, 1995. Medical records were reviewed to determine the past medical and ophthalmic history, duration of symptoms and treatment prior to referral, and the size of the ulcer at time of presentation. Treatment, culture results, and clinical course were also analyzed. During the study period, 1.8% (17 of 965) of the patients with corneal ulcers admitted to Wills Eye Hospital underwent evisceration or enucleation for microbial keratitis. The median age of the patients was 67 years (+/- 20.1 years). A majority of the patients (82%, 14 of 17) had a history of preexisting ocular disease resulting in poor visual acuity. The median duration of symptoms prior to presentation to Wills Eye Hospital was 11.4 days (+/- 13.9 days). The average size of the corneal infiltrate was 40.8 mm2 (+/- 38.7 mm2). The most common pathogens were Pseudomonas (7 cases) and Streptococcus (3 cases). Patients required evisceration (14 cases) or enucleation (3 cases) due to uncontrolled infection. Microbial keratitis resulting in loss of the eye occurred typically in patients who were elderly with preexisting poor visual acuity, who presented with severe infections due to virulent organisms or delayed treatment.

Complications and results of phacoemulsification performed by residents

The use of phacoemulsification by ophthalmic surgeons has increased markedly over the past five years. Previous studies have reported relatively high rates of vitreous loss by residents learning phacoemulsification. We retrospectively analyzed the complications and results in 300 cases of phacoemulsification with intraocular lens implantation performed by residents. The first 40 cases done by four residents in their second year of training were compared with approximately the last 40 cases done by each resident at the end of the third year. The overall rate of surgical complications was 6.3%, and the total rate of vitreous loss was 3.3%. The rate of surgical complications during the initial surgeries in the second year of residency was 9.3%; it was 3.3% by the end of the third year. The rate of vitreous loss was 5.3% in the second year and 1.3% during the third year. Postoperatively, 90.6% of all eyes had a final best corrected visual acuity of 20/40 or better (95% excluding patients with pre-existing ocular disease). With proper training and supervision, the rate of surgical complications for residents learning phacoemulsification is acceptably low when compared with the rate for extracapsular cataract extraction.

Visual outcome following traumatic wound dehiscence after cataract surgery

We reviewed the charts of 21 patients who had cataract surgery and subsequent ocular trauma with wound dehiscence. Eighteen patients were re-examined for this study; the other three were lost to follow-up. A complete examination of both eyes was performed 3 to 84 months after the trauma occurred. Patients were assigned to one of two groups: Group A, minor trauma (n = 14), or Group B, major trauma (n = 7). In Group A, visual acuity was 20/40 or better in four patients, 20/50 to 20/80 in five patients, and 20/300 or worse in three patients. In Group B, visual acuity was 20/60 or better in three patients and 20/300 or worse in three patients. Poor visual acuity was associated with endophthalmitis and bullous keratopathy in Group A and globe rupture or recurrent retinal detachment in Group B. In 14 of the 18 patients, final visual acuity in the traumatized eye was similar to that in the fellow eye, which had the same ocular pathology. This study suggests that pre-existing ocular disease is an important factor in final visual outcome in patients with traumatic wound dehiscence after cataract surgery.

Vasoproliferative tumors of the ocular fundus. Classification and clinical manifestations in 103 patients.

To describe the clinical features of vasoproliferative tumors of the ocular fundus and to propose a comprehensive classification of these tumors. A retrospective review of all cases that were diagnosed as acquired retinal hemangioma or vasoproliferative retinal tumor was conducted on the Ocular Oncology Service at Wills Eye Hospital, Philadelphia, Pa. There were 129 vasoproliferative tumors in 113 eyes of 103 patients. The tumors were classified as idiopathic in 84 eyes (74%) and secondary to preexisting ocular disease in 29 (26%). Subclassification into solitary (88 eyes), multiple (17 eyes), and diffuse (eight eyes) involvement was made. Of the 84 eyes with idiopathic tumors, 73 (87%) had solitary tumors, five (6%) had multiple tumors, and six (7%) had diffuse tumors. The lesion was located in the inferior, inferotemporal, or temporal region of the fundus in 78% and developed within 6 mm of the ora serrata retinae in 88%. Associated vitreoretinal findings included intraretinal exudation (82%), secondary exudative retinal detachment (48%), vitreous cells (46%), vitreous hemorrhage (21%), preretinal macular fibrosis (31%), and macular edema (18%). Of the 29 eyes with secondary tumors, the tumor was solitary in 15 (52%), multiple in 12 (41%), and diffuse in two (7%). The most common preexisting ocular disease included intermediate uveitis (pars planitis) in eight eyes (28%), retinitis pigmentosa in six (21%), toxoplasmic retinitis in two (7%), toxocariasis in two (7%), retinochoroidal coloboma in two (7%), and traumatic chorioretinopathy in two (7%). Retinal pigment epithelial hyperplasia was a prominent feature that was adjacent to 58% of the secondary tumors. Overall, management of the 129 tumors consisted of observation in 63 (49%), cryotherapy in 54 (42%), laser photocoagulation in seven (5%), plaque radiotherapy in three (2%), and other modes of treatment in two (2%). Vasoproliferative retinal tumors can be idiopathic, or they can develop secondary to congenital, inflammatory, vascular, traumatic, dystrophic, and degenerative ocular diseases. They can produce a variety of complications. Awareness and recognition of these tumors and differentiation from other retinal vascular tumors are important.

Comparison of the anti-inflammatory potency and local tolerance of diclofenac and indomethacin eye drops in the postoperative management of patients undergoing ECCE with PCL

Prostaglandins have been shown to mediate various manifestations of ocular inflammation. Diclofenac and indomethacin are thought to inhibit cyclooxygenase, an enzyme necessary for prostaglandin biosynthesis. The anti-inflammatory effect and subjective tolerance of topical diclofenac 0.1% and indomethacin 0.1% were examined in the postoperative treatment of 64 patients undergoing extracapsular cataract surgery with IOL implantation in a prospective, comparative, single masked study. Patients with preexisting ocular disease or whose intraoperative course was complicated were excluded from the study. Ophthalmologic examinations were performed preoperatively and at days: 1, 4-6, and 28-30 post surgery. Tolerance was assessed by subjective patient evaluation. There was no significant difference (p < 0.05) in postoperative inflammation among the two treatment groups. There was a trend for more severe corneal edema on day 4-6 in the indomethacin group. Diclofenac was slightly better tolerated.