A randomized controlled trial comparing the efficacy of topical antibiotic steroid combination versus no treatment after fornix-incision strabismus surgery

Diclofenac Versus Corticosteroids Following Strabismus Surgery: Systematic Review and Meta-analysis

The purpose of the current study was to compare outcomes of diclofenac versus corticosteroids following strabismus surgery. A systematic review and meta-analysis were performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed to include comparative studies of diclofenac versus corticosteroids following strabismus surgery. The analysis was based on fixed and random effect models. Primary outcomes included discomfort, chemosis, inflammation, conjunctival gap, intraocular pressure, and conjunctival injection. Secondary outcomes were conjunctival congestion, discharge, and drop intolerance. Eight studies with a sample of 469 eyes were included. At weeks 1 and 4 postoperatively, there were no statistically significant differences between the diclofenac and corticosteroid groups, except for conjunctival injection at week 1 (mean difference [MD] = -0.21, P = .04) favoring diclofenac. Interestingly, all primary outcomes significantly favored diclofenac at week 2: discomfort (MD = -0.34, P = .03), conjunctival chemosis (MD = -0.16, P = .04), conjunctival inflammation (MD = -0.16, P = .02), conjunctival gap (MD = -0.17, P = .002), intraocular pressure (MD = -2.53, P < .00001), and conjunctival injection (MD = -0.30, P = .03). Moreover, conjunctival congestion was significantly improved for dexamethasone, whereas discharge and drop intolerance was not statistically different. Diclofenac is comparable to various corticosteroids when used following strabismus surgery. However, it is important to note that diclofenac yielded significant improvements in discomfort, conjunctival chemosis, inflammation, conjunctival gap, intraocular pressure, and conjunctival injection, mainly at 2 weeks postoperatively. [J Pediatr Ophthalmol Strabismus. 2023;60(5):312-322.].

Strabismus Surgery: A Retrospective Comparison of Different Postoperative Treatment Regimes to Prevent Infections

BACKGROUND

As studies have shown postsurgical polyvidone-iodine to be at least equal to postsurgical topical antibiotics, our postsurgical care regime was adjusted accordingly in 2017. Here, we retrospectively compared the postsurgical infection rate in patients who underwent strabismus surgery prior to and following this change in regimen in a routine clinical setting.

PATIENTS AND METHODS

In this retrospective and explorative study, data from 162 adult patients who had undergone strabismus surgery was extracted from files: 98 patients who had received topical gentamycin in a combination ointment with steroid (postsurgery) followed by 1 week of topical gentamycin with nonsteroidal antiphlogistic eye drops for 1 week (group 1) and 64 who had received polyvidone-iodine once immediately postsurgically instead. We compared both groups' postsurgical healing period regarding occurrence of bacterial conjunctival infection and conjunctival swelling and redness as well as other complications. Data were extracted from the entries of the routine follow-up dates on postsurgical days 1, 7, and at 3 months.

RESULTS

Mean age of group 1 was 49 years and 51 years in group 2. There was no significant difference between the kind of surgeries (recessions/resections) or the number of patients who had undergone a reoperation. There was no significant difference between the groups for any of the endpoints analyzed at any of the three regular follow-up dates. From group 1, 12.04% and from of group 2, 6.25% showed bacterial conjunctivitis 1 week postsurgery. There was no endophthalmitis.

CONCLUSION

Topical polyvidone-iodine given once at the end of strabismus surgery is a good alternative to topical antibiotics with a comparable healing progress. It carries a comparable risk of infection as seen with a 1-week course of topical antibiotics. The advantages are less manipulation of the eye, no bacterial resistance caused, and cost efficiency. In addition, the lack of anti-inflammatories given in group 2 did not pose a disadvantage.

A Drug Safety Surveillance Study of a Ciprofloxacin/Dexamethasone Ophthalmic Fixed Combination in Peruvian Population

(1) Background: drugs provide a significant benefit for patients who require medical treatment; however, their use implies an intrinsic potential danger, with the possibility of causing unwanted effects. These effects are known as adverse drug reactions (ADRs). Post-marketing drug safety surveillance detects unknown risks that have not been identified in clinical trials, and it is necessary to monitor marketed medications under real-life practice. Due to the scarce information about fixed combination of ciprofloxacin 0.3%/dexamethasone 0.1% (SDO), we performed a drug safety surveillance study. (2) Methods: A prospective non-controlled drug safety surveillance study was conducted in Peruvian population. A total of 236 patients prescribed SDO were included derived from 12 sites. Patients' standardized information was collected through two phone calls, including demographics, medical history, prescribing patterns of SDO, concomitant medication, and ADRs in detail. The ADRs were classified by causality and severity, followed by outcome measures to identify new risk. (3) Results: 236 patients prescribed with SDO participated in the study and 220 were included. A total of 82 ADRs/220 patients were reported after the use of SDO, presenting a ratio 0.37 ADR/patient. The most frequent ADR with SDO administration was eye irritation (30%). All ADRs were classified as non-serious, and 97.5% (n = 80) were classified as mild while 2.5% as moderate (n = 2). No cases under the severe category were identified. (4) Conclusion: No new risks were found in the population where this study was conducted.