No topical steroids after cataract operation

Session Details

Session Title: Cataract Surgery Practice Styles

Session Date/Time: Wednesday 17/09/2014 | 08:00-09:30

Paper Time: 09:02

Venue: Boulevard B

First Author: : T.Chowdhury INDIA

Co Author(s): :    D. Dutta   P. Singhal           

Abstract Details

Purpose:

The aim of this clinical study was to evaluate the efficacy, safety and tolerability of a mixture of 1 mg preservative free intracameral triamcinolone acetonide (Aurocort ,Aurolab.Madurai.India) and sterile 0.5% moxifloxacin (Vigamox.Alcon, TX, USA) used at the conclusion of phacoemulsification with posterior chamber IOL implantation as against topical prednisolone acetate(PA) in post operative period in reducing postoperative inflammation and improve surgical outcomes in routine cataract operations.

Setting:

Disha Eye Hospital Hooghly.India

Methods:

It is a prospective randomized interventional masked study to test the efficacy of treatment protocol.A comprehensive questionnaire was completed, which included items on the patient’s age,medical and ocular history. A detailed preoperative ophthalmic evaluation was done. All routine cataract surgery cases were taken up for study. Endothelial toxicity leading to corneal decompensation is a severe complication of cataract surgery.Often iatrogenic as a result of mechanical or chemical insult to the endothelium.It is related to the chemical composition, concentration, pH, and osmolality of substances that come in contact with the endothelium. Some cases of TASS also result in localized corneal endothelial damage .The mechanical damage is standardized by including only nucleus sclerosis up to grade 3. The chemical assault on the endothelium if any will come to light by this study. Routine preoperative examination included IOP ,grade of nucleus sclerosis and specular. Institutional ethics committee approval was obtained. All patients were informed about the design of the study and all gave written informed consent. Patients were randomized into two groups in a masked manner using a random number table.Group A received 1mg of intracameral TA in 0.1ml of vigamox at the end of surgery.Group B received intracameral 0.1ml of vigamox .

Results:

Group A (n = 120) 68 women and 52 men with an average age of 63.5 ± 5.2 years. Group B (n = 110) 63 women and 47 men with an average age of 67.2 ± 5.6 years. The two groups were comparable with respect to age and sex. There were no significant differences between the groups in age or sex (p > 0.05). There were no statistically significant differences in mean VA (logMAR) between the two groups at any postoperative visit (p > 0.05). The treatment modalities used in the two groups reduced anterior chamber cells and flare equally and effectively, and no statistically significant differences were observed at any postoperative visits (p > 0.05) There were no statistically significant differences in IOP values between the two groups (p > 0.05) . Overall complaints about comfort level in Group A -- 22.2% and Group B -- 64.7% (p = 0.041) Mean endothelial cell density 90 days post operation was not significant (P=0.623) 2354 ± 54.43 (SD) cells/mm2 [loss of 5.9% ] in Group A and2421 ± 65.29 (SD)cells/mm2 [loss of 6.6% ] in Group B. The postoperative change in pachymetry was not significantly different .

Conclusions:

• Topical steroids are still needed in today’s uncomplicated cataract surgeries • Blood aqueous barrier does not reform until about six weeks after surgery. • The only real negative of steroids is intraocular pressure rise. • Triamcinolone acetonide use was associated with significantly fewer subjective complaints of discomfort, blurry vision, redness, tearing and photophobia ,more so in the first 3 weeks • Rebound inflammation after depletion of Triamcinolone in the 4th week was noted in 10% cases of group A. • TA given intracamerally appeared to be nontoxic in terms of visual rehabilitation, anterior chamber reaction ,pachymetry, and corneal endothelial cell density. • This study established that TA can safely be given intracamerally with 0.5% moxifloxacin to put patient COMFORT to a very high level. • Not even a single case reported increase of IOP in the intracameral( 1mg) TA group and it corroborates with other studies.

Financial Interest:

NONE