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Levinger E, Ostrovsky M, Friehmann A, Elhaddad O, Tole D, Darcy K, Leadbetter D, Tuuminen R, Goldberg M, Achiron A. Pseudophakic cystoid macular oedema and posterior capsular opacification rates after combined phaco-trabeculectomy vs. phaco alone. Acta Ophthalmol 2024. [PMID: 39394695 DOI: 10.1111/aos.16766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 09/14/2024] [Indexed: 10/14/2024]
Abstract
PURPOSE To assess the risk for pseudophakic cystoid macular oedema (PCME) and posterior capsular opacification (PCO) associated with combined cataract surgery and trabeculectomy compared to cataract surgery alone. METHODS Data analysis of subjects who underwent routine cataract surgery without and with concomitant trabeculectomy at the Department of Ophthalmology, Bristol Eye Hospital, the UK, between January 2008 and December 2017. Odds ratios (ORs) for PCME between the types of surgeries were calculated using univariate and multivariate regression analysis. Multivariate Cox regression controlling for age and gender was used to estimate the hazard ratio (HR) for neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomies. RESULTS This study included 56 973 cataract surgeries without and 288 with concomitant trabeculectomy (phaco-trab) with a mean follow-up time of 6.9 ± 4.2 years. Baseline variables (age and gender, diabetes, pseudoexfoliation, use of pupil expansion device and postoperative follow-up time) were comparable between the groups. Postoperative rates of PCME remained non-significant between the cataract surgery and phaco-trabe groups both in uni- and multi-variate analysis (OR 0.347, 95%CI 0.049-2.477, p = 0.291). Furthermore, in Cox regression analysis adjusted for the patients' age and gender, Nd:YAG laser capsulotomy rates remained non-significant between the cataract surgery and phaco-trabe groups (HR 1.250, 95%CI 0.883-1.769, p = 0.209). CONCLUSIONS In our large cohort study, combining trabeculectomy with cataract surgery did not predispose to an increased PCME or Nd:YAG laser capsulotomy rates.
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Affiliation(s)
- Eliya Levinger
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Ostrovsky
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Friehmann
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ophthalmology Department, Meir Medical Center, Kfar Saba, Israel
| | - Omar Elhaddad
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Derek Tole
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Kieren Darcy
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | | | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mordechai Goldberg
- Glaucoma Service, Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Asaf Achiron
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shapiro JN, Armenti ST, Levine H, Hood CT, Mian SI. Dexamethasone Intracanalicular Insert versus Standard Topical Steroids for the Prophylaxis of Inflammation after Cataract Surgery. Am J Ophthalmol 2024:S0002-9394(24)00322-2. [PMID: 39089352 DOI: 10.1016/j.ajo.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE To compare the efficacy of an intracanalicular dexamethasone intracanalicular insert (DII) to a topical prednisolone acetate 1% taper for preventing breakthrough inflammation (iritis or cystoid macular edema) during the first post-operative month (POM1) after cataract surgery DESIGN: Retrospective, non-randomized comparative interventional study METHODS: Patients received either DII or topical prednisolone acetate 1% eyedrops (control) during POM1. Exclusion criteria included history of iritis, glaucoma, intraoperative posterior capsular rupture or vitreous prolapse, immediate postoperative anterior chamber inflammation requiring treatment, or less than 1 month follow up post-operatively. Outcomes included development of breakthrough inflammation after >3 days postoperatively necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1. RESULTS 266 eyes of 174 patients were included in the DII group, and 258 eyes of 167 patients in the control group. Demographics, comorbidities, and baseline IOP were comparable between groups. The breakthrough inflammation rate was significantly higher in the DII group compared to control (9.0% vs 3.1%; p < .01); cystoid macular edema rates were similar between groups (4.9% vs 4.3%; p = .75). There were no cases of increased IOP >10mmHg at POM1 compared to baseline in either group. CONCLUSION After cataract surgery, DII demonstrated a higher rate of breakthrough inflammation than a standard topical steroid regimen with no significant differences in CME rate or IOP increase; however, overall, the rate of postoperative complications was low. DII can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery.
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Affiliation(s)
- Jeremy N Shapiro
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen T Armenti
- Scheie Eye Institute and Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harry Levine
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher T Hood
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Shahzad I Mian
- Kellogg Eye Center and Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.
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Zhou T, Yang M, Zhang J, Zhang G, Kang L, Guan H. Efficacy of the efficacy between dexamethasone versus triamcinolone acetonide after cataract surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37584. [PMID: 38847669 PMCID: PMC11155516 DOI: 10.1097/md.0000000000037584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/22/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE To evaluate the clinical effects between dexamethasone and triamcinolone acetonide (TA) after phacoemulsification and intraocular lens implantation among cataract patients. METHODS Pubmed, Embase, and the Cochrane Library were searched for studies published up to August 2020. The primary outcome was intraocular pressure. The secondary outcomes were the logarithm of the minimum angle of resolution (logMAR), anterior chamber cell, and anterior chamber flare. The pooled effect sizes were expressed as weighted mean differences (WMDs) or standardized mean differences (SMDs) of 95% confidence intervals (95% CIs). Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale criteria were used for the quality assessment of included studies. RESULTS Seven relevant studies met the inclusion criteria. For the primary outcome, there was no significant difference between TA injection and dexamethasone in comparing intraocular pressure (IOP) (SMD = 0.22, 95% confidence interval [CI] [-0.29, 0.73], P = .408; I² = 86.9%) in the first day after treatment and last day of assessment. For the secondary outcomes, the logMAR (WMD = 0.01, 95% CI [-0.06, 0.08]) and the anterior chamber flare (SMD = 0.08, 95% CI [-0.01, 0.18], P = .087; I² = 0%) showed no differences. However, the amount of anterior chamber cells (SMD = -0.21, 95% CI [-0.42, -0.01], P = .044; I² = 0%) in the TA injection on the first day postoperative was higher than for dexamethasone. After treatment, there was no difference between the 2 groups. CONCLUSIONS This study supports that there were no differences in IOP, logMAR, and anterior chamber flare between TA injection and dexamethasone among cataract patients. TA injection treatment on the first day showed higher amounts of anterior chamber cells than with dexamethasone.
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Affiliation(s)
- Tianqiu Zhou
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Mei Yang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Junfang Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Guowei Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Lihua Kang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Shorstein NH, McCabe SE, Alavi M, Kwan ML, Chandra NS. Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery. Ophthalmology 2024:S0161-6420(24)00206-9. [PMID: 38582155 DOI: 10.1016/j.ophtha.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis. DESIGN Retrospective, comparative effectiveness cohort study. PARTICIPANTS Patients at Kaiser Permanente Northern California from 2018 through 2021. INTERVENTION Exposure groups included topical PA with or without NSAID and subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0-3.0 mg) or high dose (3.1-5.0 mg). MAIN OUTCOME MEASURES The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery. RESULTS Of 69 832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively. In multivariable analysis, compared with the PA reference group, the PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74-1.04; P = 0.135). and all injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43-0.97; P = 0.033). A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups. For postoperative glaucoma-related events, compared with PA, the TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55-0.86; P = 0.001), the TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70-1.15; P = 0.40), and the TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98-2.18; P = 0.062] and OR, 2.14 [95% CI, 1.36-3.37; P = 0.001], respectively). CONCLUSIONS The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Shannon E McCabe
- Department of Ophthalmology, Kaiser Permanente, Walnut Creek, California
| | - Mubarika Alavi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Naveen S Chandra
- Department of Ophthalmology, Kaiser Permanente, Walnut Creek, California.
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Yang Q, Zhang T, Wu Y, Liang Q, Zhao W, Liu R, Jin X. Progress in the Application of Microneedles in Eye Disorders and the Proposal of the Upgraded Microneedle with Spinule. Pharm Res 2024; 41:203-222. [PMID: 38337104 DOI: 10.1007/s11095-024-03658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In the local administration methods for treating eye diseases, the application of microneedles has great potential due to the shortcomings of low efficacy and significant side effects of local administration preparations. This article provides ideas for the research on the application of ophthalmic microneedle in the treatment of eye diseases. RESULTS This article analyzes the physiological structures of the eyes, ocular diseases and its existing ocular preparations in sequence. Finally, this article reviews the development and trends of ocular microneedles in recent years, and summarizes and discusses the drugs of ocular microneedles as well as the future directions of development. At the same time, according to the inspiration of previous work, the concept of "microneedle with spinule" is proposed for the first time, and its advantages and limitations are discussed in the article. CONCLUSIONS At present, the application of ocular microneedles still faces multiple challenges. The aspects of auxiliary devices, appearance, the properties of the matrix materials, and preparation technology of ophthalmic microneedle are crucial for their application in the treatment of eye diseases.
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Affiliation(s)
- Qiannan Yang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Tingting Zhang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yujie Wu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qianyue Liang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Wanqi Zhao
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Rui Liu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China.
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Xin Jin
- Military Medicine Section, Logistics University of People's Armed Police Force, 1 Huizhihuan Road, Tianjin, 300309, Dongli District, China.
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Galvis V, Prada AM, Tello A, Parra MM, Camacho PA, Polit MP. Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3215-3221. [PMID: 37227478 PMCID: PMC10587335 DOI: 10.1007/s00417-023-06095-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Angelica Maria Prada
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia.
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia.
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Maria Margarita Parra
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
| | - Paul Anthony Camacho
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - María Paz Polit
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
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Wu AM, Pitts KM, Pineda R, Chen SH, Wang M, Johnson G, Shen LQ, Margeta MA. Steroid Response Following Dropless Cataract Surgery Using Subconjunctival Triamcinolone. Clin Ophthalmol 2023; 17:2803-2814. [PMID: 37771393 PMCID: PMC10522460 DOI: 10.2147/opth.s426200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
Purpose To assess the rates of postoperative steroid response following dropless cataract surgery using a subconjunctival depot of triamcinolone versus conventional cataract surgery using topical prednisolone. Patients and Methods We reviewed consecutive cataract surgery cases performed by a single surgeon to determine the likelihood of steroid response, defined as intraocular pressure (IOP) 50% above baseline or IOP > 24 mmHg postoperatively, excluding the first 72 hours. Logistic regression models were performed including baseline characteristics as exposures in the model and steroid response as the outcome. Main outcome measures were the proportion of eyes developing steroid response, risk factors for developing steroid response, and duration of steroid response. Results Of the 150 dropless and 218 conventional cases, 26 eyes developed steroid response (15 dropless and 11 conventional cases [10% vs 5%, P=0.096]). Risk factors for steroid response included dropless surgery (OR=2.43, 95% CI=1.03-6.02], P=0.046) and prior diagnosis of glaucoma (OR=7.18, 95% CI=2.66-19.22], P<0.001). Baseline IOP, age, sex, race, and axial length did not increase risk for steroid response. Of the eyes with steroid response, more dropless cases had an IOP elevation ≥30 days (9/15 eyes vs 1/11 eyes; P=0.008), including one patient with refractory IOP elevation in the dropless group who required urgent bilateral trabeculectomy for IOP control. Conclusion Dropless cataract surgery increases the risk of prolonged steroid response postoperatively. Patients with glaucoma have an increased risk of steroid response and may not be good candidates for dropless cataract surgery with subconjunctival triamcinolone.
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Affiliation(s)
- Annie M Wu
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Kristen M Pitts
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Roberto Pineda
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Sherleen H Chen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Grace Johnson
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy Q Shen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Milica A Margeta
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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8
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Hosseini K, Gollamudi S, Reiser H, Walters T, Lindstrom RL. 0.2% Betamethasone Sodium Phosphate: A Multicenter, Randomized, Double-Masked Study to Compare Its Ocular Safety, Tolerability, and Efficacy to Vehicle in Cataract Surgery Subjects. Clin Ophthalmol 2023; 17:2219-2230. [PMID: 37564159 PMCID: PMC10411451 DOI: 10.2147/opth.s419857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To compare the preservative-free corticosteroid 0.2% betamethasone sodium phosphate BID (SURF-201) to vehicle BID in patients undergoing routine cataract surgery. Methods Phase 2, multicenter, randomized (1:1 ratio), double-masked, vehicle-controlled, parallel-group study in patients scheduled for uncomplicated cataract surgery without the aid of a femtosecond laser. Subjects instilled topical medications for 16 days beginning the day before cataract surgery (Day -1), 1 dose administered at least 1 hour prior to cataract surgery (on Day 0) and 1 dose on the evening after cataract surgery, and then 2 doses administered each day through Day 15; patients were re-evaluated on Days 22 and 32 to ensure no rebound inflammation. Primary outcome was the difference in the proportion of subjects with anterior chamber cell (ACC) grade 0 between the two groups at Day 15. Secondary outcomes included pain scores and overall safety. Results There was a statistically significant difference (P=0.004) in the proportion of subjects in the SURF-201 treatment group with an ACC grade of 0 at Day 15 (n=22/39 [56.4%]) compared to subjects in the vehicle treatment group (n=9/43 [20.9%]). There was no statistically significant difference (P=0.528) in the proportion of subjects in the SURF-201 treatment group who had a visual analog scale pain score of 0 at Day 15 (n=35/38 [89.7%]) compared to subjects in the vehicle group (n=33/40 [82.5%]). A slightly higher incidence of adverse events occurred in subjects in the SURF-201 treatment group (n=27/40 [67.5%]) compared to the vehicle treatment group (n=23/43 [53.5%]). Conclusion SURF-201 is an effective topical, preservative-free corticosteroid when dosed BID for the treatment of postoperative inflammation and prevention of pain in a post-cataract population.
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Affiliation(s)
| | | | | | - Tom Walters
- Texan Eye, PA — Keystone Research, Austin, TX, USA
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Wotipka EK, Wright AJ, Fan JZ, Fuhriman D, Chuang AZ, Lindhorst GC, Feldman RM, Crowell EL. Postoperative Complications of True Dropless Cataract Surgery versus Standard Topical Drops. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e144-e153. [PMID: 37564162 PMCID: PMC10411064 DOI: 10.1055/s-0043-1771043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Purpose Compare postoperative outcomes in cataract surgery between eyes with standard drop regimen versus dropless protocol by residents. Design Retrospective cohort study between April 1, 2018 and March 31, 2020. Methods The study was performed at Lyndon B. Johnson General Hospital in Houston, Harris County, Texas. A total of 547 eyes (234 dropless vs. 313 standard) with phacoemulsification cataract surgery and minimum of 1-month follow-up with best-corrected visual acuity (BCVA) were included. Dropless received 40 mg sub-Tenon's triamcinolone and intracameral moxifloxacin. Patients were followed at postoperative day 1 (POD1), week 1 (POW1), and month 1 (POM1). Postoperative rate of BCVA better than 20/40 (Good vision) and rate of complications were compared between groups. Results Good vision on POM1 in dropless (77.8%) was noninferior to standard (75.1%, p = 0.80). Complication rate in dropless (28.6%) was noninferior to standard (24.0%, p = 0.13). Intraocular pressure (IOP) elevation on POD1 ( p = 0.041) and anterior chamber (AC) cells on POW1 and POM1 ( p < 0.001) were more frequent in dropless. Mean spherical equivalent at POM1 was better in dropless (-0.37 D [±0.81 D]) compared with standard (-0.61D [±0.77 D], p = 0.001). Early posterior capsular opacification (early PCO) was more frequent in dropless ( p = 0.042). Conclusions Postoperative rate of BCVA better than 20/40 and rate of postoperative complications were noninferior, although dropless had higher rates of AC inflammation, IOP elevation, and early PCO.
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Affiliation(s)
- Evan K. Wotipka
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Alex J. Wright
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - James Z. Fan
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - David Fuhriman
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Grace C. Lindhorst
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Robert M. Feldman
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Eric L. Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Department of Ophthalmology, Dell Medical School, Austin, Texas
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10
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Garcia-O'Farrill N, Brown GT, Hunter AA. Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot study. BMC Ophthalmol 2023; 23:195. [PMID: 37142977 PMCID: PMC10157951 DOI: 10.1186/s12886-023-02943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Perioperative infection and inflammation prophylaxis after ocular surgery has evolved over the years along with improvements in surgical equipment and a growing interest in alternatives to the standard topical eye drops. The purpose of this study is to evaluate the outcomes of a novel, modified-dropless protocol for 23-gauge (23-G), 25-gauge (25-G) and 27-gauge (27-G) micro-incision vitrectomy surgery (MIVS) that omits any intraocular injections of antibiotics or steroids. METHODS This Institutional Review Board-approved, single-surgeon retrospective study reviewed MIVS post-surgical outcomes in patients who received a modified-dropless protocol from February 2020 to March 2021. A total of 158 charts were reviewed, of which 150 eyes met the eligibility criteria. After each case, patients were administered a 0.5 cc subconjunctival injection of a 1:1 Cefazolin (50 mg/cc):Dexamethasone (10 mg/cc) in the inferior fornix and 0.5 cc of posterior Sub-Tenon's Kenalog (STK). No intravitreal injections were administered, and no pre- or postoperative antibiotic or steroid eye drops were prescribed. For patients allergic to penicillin, separate subconjunctival injections of 0.25 cc each of Vancomycin (10 mg/cc) and Dexamethasone (10 mg/cc) were administered. The primary safety parameter was postoperative cases of endophthalmitis. Secondary endpoints consisted of Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and postoperative complications (retinal detachments, inflammation, need for additional surgery) within three months of surgery. Statistical analysis was performed using chi-square (χ²) tests for categorical values, and a Student's t-test to compare continuous outcomes. RESULTS The majority of surgeries (96%) were performed with the 27G MIVS platform. There were no cases of postoperative endophthalmitis. Mean logMAR BCVA improved from 0.71 (± 0.67) to 0.61 (± 0.60) post-operatively (p = 0.02). Excluding patients who had silicone oil tamponade, postoperative BCVA improved from 0.67 (± 0.66) to 0.54 (± 0.55) (p = 0.003). Mean IOP increased from 14.6 (± 3.8) to 15.3 (± 4.1) (p = 0.05). Ten patients required further medication therapy for an increase in IOP, one had inflammatory signs, and 14 required a second surgical intervention mostly due to recurrences of initial surgical indication. CONCLUSION A modified-dropless postoperative protocol involving subconjunctival and posterior sub-Tenon's injections only may be a safe and convenient alternative to topical eye drops for patients undergoing MIVS, but additional and larger studies are needed.
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Affiliation(s)
- Noraliz Garcia-O'Farrill
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA.
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA.
| | - Gordon T Brown
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
| | - Allan A Hunter
- Oregon Eye Consultants LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
- Cascade Medical Research Institute LLC, 3783 International Court, Suite 290, Springfield, OR, 97477, USA
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11
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Wu KY, Joly-Chevrier M, Akbar D, Tran SD. Overcoming Treatment Challenges in Posterior Segment Diseases with Biodegradable Nano-Based Drug Delivery Systems. Pharmaceutics 2023; 15:1094. [PMID: 37111579 PMCID: PMC10142934 DOI: 10.3390/pharmaceutics15041094] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Posterior segment eye diseases present a challenge in treatment due to the complex structures in the eye that serve as robust static and dynamic barriers, limiting the penetration, residence time, and bioavailability of topical and intraocular medications. This hinders effective treatment and requires frequent dosing, such as the regular use of eye drops or visits to the ophthalmologist for intravitreal injections, to manage the disease. Moreover, the drugs must be biodegradable to minimize toxicity and adverse reactions, as well as small enough to not affect the visual axis. The development of biodegradable nano-based drug delivery systems (DDSs) can be the solution to these challenges. First, they can stay in ocular tissues for longer periods of time, reducing the frequency of drug administration. Second, they can pass through ocular barriers, offering higher bioavailability to targeted tissues that are otherwise inaccessible. Third, they can be made up of polymers that are biodegradable and nanosized. Hence, therapeutic innovations in biodegradable nanosized DDS have been widely explored for ophthalmic drug delivery applications. In this review, we will present a concise overview of DDSs utilized in the treatment of ocular diseases. We will then examine the current therapeutic challenges faced in the management of posterior segment diseases and explore how various types of biodegradable nanocarriers can enhance our therapeutic arsenal. A literature review of the pre-clinical and clinical studies published between 2017 and 2023 was conducted. Through the advances in biodegradable materials, combined with a better understanding of ocular pharmacology, the nano-based DDSs have rapidly evolved, showing great promise to overcome challenges currently encountered by clinicians.
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Affiliation(s)
- Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada;
| | | | - Dania Akbar
- Department of Human Biology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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12
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Nemet A, Kanclerz P, Tuuminen R. Should Multifocal Intraocular Lenses Become a Standard in Phacoemulsification Cataract Surgery? J Clin Med 2023; 12:jcm12051983. [PMID: 36902768 PMCID: PMC10004625 DOI: 10.3390/jcm12051983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Cataracts impair daily activities such as reading, outdoor sports, and driving, which may not match best-corrected visual acuity at optimal room light conditions, but can be just as important to patients [...].
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Affiliation(s)
- Achia Nemet
- Department of Ophthalmology, Assuta Ashdod University Medical Center, Ashdod 7747629, Israel
| | - Piotr Kanclerz
- Helsinki Retina Research Group, University of Helsinki, 00290 Helsinki, Finland
- Hygeia Clinic, 80-286 Gdańsk, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, 00290 Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka Hygeia Clinic, 48210 Gdańsk, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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13
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Hirabayashi MT, Barnett BP. Solving STODS-Surgical Temporary Ocular Discomfort Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13050837. [PMID: 36899981 PMCID: PMC10000827 DOI: 10.3390/diagnostics13050837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/24/2023] Open
Abstract
The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing.
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Affiliation(s)
- Matthew T. Hirabayashi
- Department of Ophthalmology, University of Missouri School of Medicine, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Brad P. Barnett
- California LASIK & Eye, 1111 Exposition Blvd. Bldg. 200, Ste. 2000, Sacramento, CA 95815, USA
- Correspondence:
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14
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[Position Paper and Recommendations for Action for Ecologically Sustainable Ophthalmology - Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. Klin Monbl Augenheilkd 2023; 240:198-217. [PMID: 36812927 DOI: 10.1055/a-2015-1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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15
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Cong YY, Fan B, Zhang ZY, Li GY. Implantable sustained-release drug delivery systems: a revolution for ocular therapeutics. Int Ophthalmol 2023:10.1007/s10792-023-02637-x. [PMID: 36715956 DOI: 10.1007/s10792-023-02637-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE Due to the inimitable anatomical structure of the eyeball and various physiological barriers, conventional ocular local administration is often complicated by apparent shortcomings, such as limited bioavailability and short drug retention. Thus, developing methods for sustainable, safe and efficient drug delivery to ocular target sites has long been an urgent need. This study briefly summarizes the barriers to ocular drug administration and various ocular drug delivery routes and highlights recent progress in ocular implantable sustained-release drug delivery systems (DDSs) to provide literature evidence for developing novel ocular implants for sustained drug delivery. METHODS We conducted a comprehensive search of studies on ocular implantable sustained-release DDSs in PubMed and Web of Science using the following keywords: ocular, implantable and drug delivery system. More than 400 papers were extracted. Publications focused on sustained and controlled drug release were primarily considered. Experimental articles involving DDSs that cannot be implanted into the eye through surgeries and cannot be inserted into ocular tissues in solid form were excluded. Approximately 143 publications were reviewed to summarize the most current information on the subject. RESULTS In recent years, numerous ocular sustained-release DDSs using lipids, nanoparticles and hydrogels as carriers have emerged. With unique properties and systematic design, ocular implantable sustained-release DDSs are able to continuously maintain drug release, effectively sustain the therapeutic concentration in target tissues, and substantially enhance the therapeutic efficacy. Nevertheless, few ocular implantable sustained-release DDSs have been available in clinical use. CONCLUSIONS Ocular implantable sustained-release DDSs have become a new focus in the field of ocular drug development through unique designs and improvements in the materials of drug carriers, administration methods and dosage forms. With more ocular implantable sustained-release DDSs being commercialized, ocular therapeutics may be revolutionized.
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Affiliation(s)
- Yun-Yi Cong
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130000, China
| | - Bin Fan
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130000, China
| | - Zi-Yuan Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130000, China
| | - Guang-Yu Li
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, 130000, China.
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16
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[Position paper and recommendations for action for ecologically sustainable ophthalmology : Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. DIE OPHTHALMOLOGIE 2023; 120:52-68. [PMID: 36625883 PMCID: PMC9838365 DOI: 10.1007/s00347-022-01792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
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17
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Management of inflammation after the cataract surgery. Curr Opin Ophthalmol 2023; 34:9-20. [PMID: 36305352 DOI: 10.1097/icu.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery. RECENT FINDINGS FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most cost-effective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drug-loaded IOLs. SUMMARY Inflammation after the cataract surgery can be prevented, and these methods are one of the most essential topics with growing phacoemulsification rate. Topical NSAIDs are cost-effective not only for patients with risk factors for PCME but also for healthy subjects. New dropless techniques are being successfully introduced in the clinical practice.
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18
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Karasu B, Kesim E, Kaskal M, Celebi ARC. Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide. Cutan Ocul Toxicol 2022; 41:310-317. [DOI: 10.1080/15569527.2022.2136193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Buğra Karasu
- Department of Ophthalmology, Tuzla State Hospital, Istanbul, Turkey
| | - Enes Kesim
- Department of Ophthalmology, Tuzla State Hospital, Istanbul, Turkey
| | - Mert Kaskal
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- School of Medicine, Department of Ophthalmology, Acibadem University, Istanbul, Turkey
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19
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Birtel J, Heimann H, Hoerauf H, Helbig H, Schulz C, Holz FG, Geerling G. [Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation]. Ophthalmologe 2022; 119:567-576. [PMID: 35451609 PMCID: PMC9024069 DOI: 10.1007/s00347-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Großbritannien.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Großbritannien.
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland.
| | - Heinrich Heimann
- St. Paul's Eye Unit, Royal Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Christian Schulz
- Deutsche Allianz Klimawandel und Gesundheit, Berlin, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Gerd Geerling
- Klinik für Augenheilkunde, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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20
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Zhao J, Li Z, Puri R, Liu K, Nunez I, Chen L, Zheng S. Molecular profiling of individual FDA-approved clinical drugs identifies modulators of nonsense-mediated mRNA decay. MOLECULAR THERAPY. NUCLEIC ACIDS 2022; 27:304-318. [PMID: 35024243 PMCID: PMC8718828 DOI: 10.1016/j.omtn.2021.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
Nonsense-mediated mRNA decay (NMD) degrades transcripts with premature stop codons. Given the prevalence of nonsense single nucleotide polymorphisms (SNPs) in the general population, it is urgent to catalog the effects of clinically approved drugs on NMD activity: any interference could alter the expression of nonsense SNPs, inadvertently inducing adverse effects. This risk is higher for patients with disease-causing nonsense mutations or an illness linked to dysregulated nonsense transcripts. On the other hand, hundreds of disorders are affected by cellular NMD efficiency and may benefit from NMD-modulatory drugs. Here, we profiled individual FDA-approved drugs for their impact on cellular NMD efficiency using a sensitive method that directly probes multiple endogenous NMD targets for a robust readout of NMD modulation. We found most FDA-approved drugs cause unremarkable effects on NMD, while many elicit clear transcriptional responses. Besides several potential mild NMD modulators, the anticancer drug homoharringtonine (HHT or omacetaxine mepesuccinate) consistently upregulates various endogenous NMD substrates in a dose-dependent manner in multiple cell types. We further showed translation inhibition mediates HHT's NMD effect. In summary, many FDA drugs induce transcriptional changes, and a few impact global NMD, and direct measurement of endogenous NMD substrate expression is robust to monitor cellular NMD.
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Affiliation(s)
- Jingrong Zhao
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
| | - Zhelin Li
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
| | - Ruchira Puri
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
| | - Kelvin Liu
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
| | - Israel Nunez
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
| | - Liang Chen
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA 90089, USA
| | - Sika Zheng
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA 91709, USA
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Taubenslag KJ, Kim SJ, Grzybowski A. Anti-inflammatory Pharmacotherapy for the Prevention of Cystoid Macular Edema After Cataract Surgery. Am J Ophthalmol 2021; 232:1-8. [PMID: 34157275 DOI: 10.1016/j.ajo.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To elucidate strategies for and controversies surrounding the use of anti-inflammatory medications after uneventful cataract surgery, with a focus on the prevention of irreversible vision loss due to cystoid macular edema (CME). DESIGN Perspective. METHODS Expert commentary on the management of inflammation after cataract surgery. Discussion includes combination therapy with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), dosing strategies, and emerging therapies. RESULTS While prescribing both NSAIDs and corticosteroids for cataract surgery is common, these classes have overlapping mechanisms. Combination therapy may speed visual recovery, but there remains little evidence for improved long-term visual outcomes from NSAIDs. The last 2 decades have seen increasing data on potential benefits of pretreatment with NSAIDs 1-3 days prior to cataract surgery. Simultaneously, newly approved "dropless" delivery systems hold promise, and clinical trials are ongoing to assess outcomes of such formulations. CONCLUSIONS Optimal pharmacologic treatment for inflammation after cataract surgery remains controversial. A consensus definition for clinically significant CME may facilitate the comparison of anti-inflammatory drugs. And there remains a need for well-designed trials examining both topical and extended-release drug-delivery systems to refine the treatment paradigm.
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22
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Recent advances in ophthalmic preparations: Ocular barriers, dosage forms and routes of administration. Int J Pharm 2021; 608:121105. [PMID: 34537269 DOI: 10.1016/j.ijpharm.2021.121105] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The human eye is a complex organ with unique anatomy and physiology that restricts the delivery of drugs to target ocular tissues/sites. Recent advances in the field of pharmacy, biotechnology and material science have led to development of novel ophthalmic dosage forms which can provide sustained drug delivery, reduce dosing frequency and improve the ocular bioavailability of drugs. This review highlights the different anatomical and physiological factors which affect ocular bioavailability of drugs and explores advancements from 2016 to 2020 in various ophthalmic preparations. Different routes of drug administration such as topical, intravitreal, intraocular, juxtascleral, subconjunctival, intracameral and retrobulbar are discussed with their advances and limitations.
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23
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Aaronson A, Taipale C, Achiron A, Aaltonen V, Grzybowski A, Tuuminen R. Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery. Transl Vis Sci Technol 2021; 10:15. [PMID: 34125145 PMCID: PMC8212433 DOI: 10.1167/tvst.10.7.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/12/2021] [Indexed: 01/31/2023] Open
Abstract
Purpose To assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients. Methods A post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery. Results Aqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT (P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare (P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups. Conclusions At 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy. Translational Relevance A 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Claudia Taipale
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel and Sackler School of Medicine, Tel Aviv University, Israel
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Vesa Aaltonen
- Department of Ophthalmology, Turku University Hospital, Turku, Finland
- Department of Ophthalmology, University of Turku, Turku, Finland
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Erichsen JH, Forman JL, Holm LM, Kessel L. Effect of anti-inflammatory regimen on early postoperative inflammation after cataract surgery. J Cataract Refract Surg 2021; 47:323-330. [PMID: 33086290 DOI: 10.1097/j.jcrs.0000000000000455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether a combination of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a sub-Tenon depot of steroid was placed during surgery. SETTING Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark. DESIGN Prospective randomized controlled trial with masked statistical analyses. METHODS Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eyedrops combined (Pred+NSAID-Pre [control group] and Pred+NSAID-Post group) vs ketorolac monotherapy (NSAID-Pre and NSAID-Post groups) vs sub-Tenon depot of dexamethasone (dropless group). Drops were used until 3 weeks postoperatively, starting 3 days preoperatively in the Pre groups and on the day of surgery in the Post groups. Aqueous flare was measured at baseline and 3 days postoperatively. RESULTS Four hundred fifty-six participants, with a mean age of 72.1 (SD 7.0) years and 283 (62%) women, were included. Flare increased significantly more in the dropless group compared with the control group (Pred+NSAID-Pre), but none of the other groups differed significantly from the control group. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eyedrops (Pred+NSAID-Pre and Pred+NSAID-Post groups) compared with NSAID monotherapy and dropless groups. No differences in postoperative visual acuity were found compared with the control group. CONCLUSIONS No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery, but sub-Tenon depot of dexamethasone was less efficient. Initiating prophylactic eyedrops prior to surgery did not influence early postoperative anterior chamber inflammation.
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Affiliation(s)
- Jesper H Erichsen
- From the Department of Ophthalmology, Rigshospitalet-Glostrup (Erichsen, Holm, Kessel), Glostrup, Section of Biostatistics, Department of Public Health (Forman), Department of Clinical Medicine (Holm, Kessel), University of Copenhagen, Copenhagen, Denmark
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Sarkar S, Kasturi N, Bardoloi N. Minimizing topical medication in cataract surgery. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Qu Y, Liu XS, Liang AY, Xiao JY, Zhao C, Gao F, Zhang MF. Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema. Int J Ophthalmol 2020; 13:1087-1091. [PMID: 32685396 DOI: 10.18240/ijo.2020.07.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide (TA) injections for treating uveitic macular edema (UME). METHODS This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6mo. The main outcome measure was central macular thickness (CMT). The secondary outcome measures included best-corrected visual acuity (BCVA), recurrence rate and intraocular pressure (IOP). RESULTS In total, 65 patients (80 eyes), mainly including idiopathic uveitis in 33 patients (50.77%) and Vogt-Koyanagi-Harada (VKH) syndrome in 19 patients (29.23%), were enrolled in this study. The mean CMT decreased from 457.6±173.0 µm at baseline to 325.9±176.8, 302.7±148.2, 332.2±177.3 and 270.6±121.6 µm at 1-, 2-, 3- and 6-months postinjection, respectively (all P<0.001). BCVA increased from logMAR 0.5±0.3 at baseline to logMAR 0.4±0.3, 0.4±0.3, 0.4±0.4 and 0.4±0.3 at the 1-, 2-, 3- and 6-months postinjection visits, respectively (all P<0.001). Twenty-one (21/80, 26.25%) eyes underwent relapse of UME within 6mo. A total of 20/80 (25%) eyes exhibited elevated IOPs, of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit. CONCLUSION Subconjunctival TA injections appear to be safe and effective for UME.
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Affiliation(s)
- Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin-Shu Liu
- Department of Ophthalmology, the Fourth People's Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - An-Yi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mei-Fen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Should intracameral triamcinolone acetonide become a mainstay in infantile cataract surgery? Graefes Arch Clin Exp Ophthalmol 2020; 258:1839-1840. [PMID: 32462342 DOI: 10.1007/s00417-020-04766-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
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