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Anti-inflammatory medication after cataract surgery and posterior capsular opacification

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First Author: I.Hecht ISRAEL

Co Author(s):    P. Karesvuo   A. Achiron   U. Elbaz   I. Laine   R. Tuuminen        

Abstract Details

Purpose:

Previous pilot studies analysing the role of NSAIDs in the formation of PCO have shown contradictory results. It was suggested that postoperative use of topical NSAIDs may reduce formation of PCO. Nevertheless, no large-scale real-life evidence existed to date. The aim of this study was to assess the role of anti-inflammatory medication following cataract surgery on the formation of posterior capsular opacification.

Setting:

Retrospective registry analysis of 25,818 consecutive cases who underwent cataract surgery between the years 2014 and 2018 at Helsinki University Hospital in Finland.

Methods:

Nd:YAG laser capsulotomy rates were compared between patients treated postoperatively with topical steroids, non-steroidal anti-inflammatory medications (NSAIDs), or their combination. Kaplan-Meier and Cox regression analyses were used. A single eye of each patient was included. Main outcomes were confirmed against a second independent dataset.

Results:

13,368 patients were included. The mean age was 73.2±9.7 years and mean follow-up time was 22.8±15.7 months. Patients were treated with steroid monotherapy (28.9% of cases), NSAIDs monotherapy (62.2%), or a combination of both (8.9%). Treatment with steroids resulted in significantly lower Nd:YAG capsulotomy rates compared to NSAIDs (HR 0.76, 95% CI 0.62-0.93, P=0.009). Treatment with combination therapy of steroids and NSAIDs showed no added benefit over steroid monotherapy (HR 1.11, 95% CI 0.68-1.80, P=0.674). Multivariant analysis adjusted for confounders remained predictive for lower capsulotomy rates with steroid over NSAIDs (HR 0.70, 95% CI 0.52-0.88, P=0.001).

Conclusions:

Postoperative treatment with steroids among patients undergoing uncomplicated cataract surgery was associated with lower rates of clinically significant posterior capsule opacification compared to treatment with NSAIDs alone. Combination therapy of steroids and NSAIDs had no added benefit over steroids alone.

Financial Disclosure:

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