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Haddad JE, Sabbakh NA, Macaron MM, Shaaban H, Bourdakos NE, Shi A, Saad B, Nakanishi H, Than CA, Daoud YJ. NSAIDs and Corticosteroids for the Postoperative Management of Age-Related Cataract Surgery: A Systematic Review and Meta-analysis. Am J Ophthalmol 2024; 260:1-13. [PMID: 37797866 DOI: 10.1016/j.ajo.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/10/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in the postoperative management of cataract surgery for age-related cataract in adults. DESIGN Meta-analysis. METHODS Cochrane, Embase, PubMed, Scopus, Web of Science and CINAHL were searched for articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022364733). Randomized controlled trials of patients undergoing age-related cataract surgery treated with corticosteroids, NSAIDs, or a combination were included. RESULTS A total of 19 studies were included, with 3473 patients (3638 eyes) treated following cataract surgery with NSAIDs (n = 1479), corticosteroids (n = 1307), or a combination (n = 687). Combination treatment demonstrated favorable best-corrected visual acuity compared to corticosteroids 4 to 6 weeks postoperatively (MD = -0.01 logMAR, 95% CI: -0.02, -0.01, I2 = 0%). NSAIDs had more favorable flare values than corticosteroids on day 7 (MD = -9.17 photons/ms, 95% CI = -16.52, -1.82, I2 = 94%), day 14 (MD = -5.23 photons/ms, 95% CI = -8.35, -2.11, I2 = 94%), and 4 to 6 weeks (MD = -1.62 photons/ms, 95% CI = -3.03, -0.20, I2 = 93%) postoperatively. Furthermore, 4 to 8 weeks postoperatively, patients treated with NSAIDs showed lower central macular thickness (MD = -13.26 µm, 95% CI = -18.66, -7.86, I2 = 81%) compared to those treated with corticosteroids. NSAIDs and combination treatment were associated with a lower incidence of central macular edema (OR = 0.16, 95% CI = 0.07, 0.35, I2 = 61%; OR = 0.21, 95% CI = 0.10, 0.45, I2 = 31%) than corticosteroids 4 to 8 weeks postoperatively. CONCLUSIONS NSAIDs and combination treatments could be regarded as more effective and safer alternatives to corticosteroids alone in the postoperative management of cataract surgery. Further studies should be conducted to determine why this evidence has not been reflected in practice patterns, and to further compare the effectiveness of NSAIDs and combination treatments.
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Affiliation(s)
- Joe El Haddad
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Nader Al Sabbakh
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Marie Michele Macaron
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Hashim Shaaban
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Natalie E Bourdakos
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Ao Shi
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Baraa Saad
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Hayato Nakanishi
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Christian A Than
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus; School of Biomedical Sciences (C.A.T.), The University of Queensland, St Lucia, Australia
| | - Yassine J Daoud
- The Wilmer Eye Institute (Y.J.D.), The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Almobarak FA, Alrubean A, Alsarhani WK, Aljenaidel A, Osman EA. Two-Year Outcomes of Ultrasound Cyclo Plasty as a First Procedure in Glaucoma. Semin Ophthalmol 2023:1-8. [PMID: 36762779 DOI: 10.1080/08820538.2023.2170715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE To evaluate the 2-year outcomes of ultrasound cyclo plasty (UCP) as a first procedure in glaucoma. METHODS This retrospective cohort study included patients with uncontrolled glaucoma who underwent UCP as an initial glaucoma procedure. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, visual acuity, and the presence of vision-threatening complications. Surgical outcomes of each eye were classified as either complete success, qualified success, or failure based on the main outcome measures. Differences in IOP control and success rates were compared in eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). RESULTS We included 98 eyes of 88 patients in the study. The mean follow-up period was 27.25 ± 10.1 months. At 12 and 24 months, mean IOP decreased significantly from 23.16 ± 6.4 mmHg to 16.57 ± 6.0 mmHg and 16.18 ± 5.2 mmHg, respectively, and the number of antiglaucoma medications decreased from 3.27 ± 0.9 to 1.86 ± 1.4 and 1.70 ± 1.7, respectively (p < .01 for all). There were no changes in visual acuity throughout the follow-up compared with preoperative levels. The cumulative probabilities of success were 64.3% (±4.8) [78.9% (±9.4) complete success, and 72.9% (±6.4) qualified success], and 42.9% (±5.0) [52.6% (±11.5) complete success, and 56.3% (±7.2) qualified success] at 12 and 24 months, respectively. The most common complications were cataract development/progression, anterior chamber inflammation, and macular edema. There were no significant differences in IOP, number of antiglaucoma medications, or survival rates between POAG and PACG groups. CONCLUSIONS UCP can be used as an initial glaucoma procedure for reducing IOP and the number of antiglaucoma medications and offers comparable outcomes in POAG and PACG.
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Affiliation(s)
- Faisal A Almobarak
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
| | - Ahmed Alrubean
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Abdullah Aljenaidel
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Essam A Osman
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
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Lima-Fontes M, Leuzinger-Dias M, Barros-Pereira R, Fernandes V, Falcão M, Falcão-Reis F, Rocha-Sousa A, Alves-Faria P. Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy. Ophthalmol Ther 2023; 12:377-388. [PMID: 36417092 PMCID: PMC9834446 DOI: 10.1007/s40123-022-00613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. METHODS This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. RESULTS Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm, and IOP was 15.4 ± 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (44.0 ± 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 ± 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. CONCLUSION FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.
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Affiliation(s)
- Mário Lima-Fontes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Leuzinger-Dias
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Barros-Pereira
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vítor Fernandes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Falcão
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Alves-Faria
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Way C, Swampillai AJ, Lim KS, Nanavaty MA. Factors influencing aqueous flare after cataract surgery and its evaluation with laser flare photometry. Ther Adv Ophthalmol 2023; 15:25158414231204111. [PMID: 38107248 PMCID: PMC10725112 DOI: 10.1177/25158414231204111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Despite the refinement of modern cataract surgery, postoperative inflammation still constitutes a substantial amount of visual morbidity worldwide. A surrogate for intraocular inflammation and blood-aqueous barrier breakdown can be objectively quantified by Laser flare photometry (LFP). This review outlines the utility of LFP in assessing the assessment of post-cataract surgery inflammation. It highlights the impact of preoperative pathological states such as uveitis and diabetes, intraoperative techniques, including efficient phacoemulsification and direct comparisons between postoperative anti-inflammatory regimes. There is a large interobserver variation in the subjective flare measurement after cataract surgery and the continued use of LFP amongst other objective, noninvasive measurements of intraocular inflammation, particularly in the further development of cataract surgery, is recommended.
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Affiliation(s)
- Christopher Way
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Andrew J. Swampillai
- Department of Ophthalmology, St. Thomas’ Hospital, London, UK
- School of Life Course & Population Sciences, King’s College London, London, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, St. Thomas’ Hospital, London, UK
- School of Life Course & Population Sciences, King’s College London, London, UK
| | - Mayank A. Nanavaty
- University Hospitals Sussex NHS Foundation Trust, Sussex Eye Hospital, Eastern Road, Brighton, BN2 5BF, UK
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
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Karesvuo M, Häyry S, Karesvuo P, Kanclerz P, Tuuminen R. Association between periodontitis and blood-ocular barrier disruption. Eur J Ophthalmol 2022; 33:1473-1479. [PMID: 36529928 DOI: 10.1177/11206721221146672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Periodontitis causes low-grade systemic inflammation e.g., through circulatory periodontal endotoxins, and it has been associated with cardiovascular morbidity and wet age-related macular degeneration. Methods To assess the association between clinical severity of periodontitis and aqueous flare levels in the eyes. Patients with periodontitis (N = 15) who underwent periodontal treatment by a specialized dentist between the years 2020 and 2021 at the Chin and Mouth Disease Unit, Kymenlaakso Central Hospital, Kotka, Finland were enrolled. Aqueous flare levels, a surrogate marker for blood-aqueous and blood-retinal-barrier disruption, were measured using Laser Flare Meter (FM-600, Kowa Company, Ltd., Nagoya, Japan) before and right after the periodontal treatment and at 3 months. The number of teeth, periodontal probing depth (PPD), periodontal pathogens and antimicrobial treatment were recorded. Results At baseline, aqueous flare levels correlated with the number of clinically-relevant PPD (>5 mm) pockets (R = 0.789, P < 0.001) and inversely correlated with the number of teeth (R = −0.587, P = 0.035). At baseline, aqueous flare levels were 15.39 ± 13.24 photon units (pu)/ms among patients with periodontal pathogens, compared with 3.29 ± 1.67 pu/ms among those without any peridontal pathogens in PCR ( P = 0.018). At 3 months compared to baseline values, aqueous flare levels were reduced to <50% from baseline among 6 patients (40%), whereas the levels increased to >200% from baseline in 1 patient (7%) (repeated measures ANOVA, P < 0.026). Conclusions Poor periodontal status was associated with blood-ocular-barrier breakdown. These findings could expand our understanding of the potential mechanisms and therapeutic targets against retinal vascular diseases and systemic comorbidities in patients with periodontitis.
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Affiliation(s)
- Minna Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Health Services Dental Care, City of Helsinki, Helsinki, Finland
| | - Sam Häyry
- Chin and Mouth Disease Unit, Kymenlaakso Central Hospital, Kotka, Finland
| | - Petteri Karesvuo
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland
| | - Piotr Kanclerz
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Hygeia Clinic, Gdańsk, Poland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Kunikata H, Tawarayama H, Tsuda S, Akaike T, Nakazawa T. Development of an anti-oxidative intraocular irrigating solution based on reactive persulfides. Sci Rep 2022; 12:19243. [PMID: 36357454 PMCID: PMC9649782 DOI: 10.1038/s41598-022-21677-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
Anti-oxidative intraocular irrigating solutions (IISs) based on reactive persulfides, such as oxidized glutathione disulfide (GSSG), are commonly used worldwide. However, even with GSSG-based IISs, it has been shown that oxidative stress can occur during surgery, posing a risk to intraocular tissues. This study compared two IISs: one containing GSSG and one containing an oxidized glutathione trisulfide (GSSSG). Experimental in vivo irrigation with the IISs in rabbits showed that there was less leakage into the anterior chamber of rabbit serum albumin during perfusion with a 300-μM GSSSG IIS than with a 300-μM GSSG IIS. Experimental in vivo cataract surgery in rabbits showed that aqueous flare was suppressed 3 days after surgery with a 600-μM GSSSG IIS, but not with a 300-μM GSSSG or 300-μM GSSG IIS. Furthermore, an in vitro experiment, without any live tissue, showed that reactive oxygen species were suppressed more strongly with a 600-μM GSSSG IIS than with a 300-μM GSSG IIS. Thus, this study found that novel IISs based on GSSSG had anti-inflammatory and anti-oxidative effects during and after intraocular surgery and may decrease the rate of complications after surgery.
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Affiliation(s)
- Hiroshi Kunikata
- grid.69566.3a0000 0001 2248 6943Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan ,grid.69566.3a0000 0001 2248 6943Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Tawarayama
- grid.69566.3a0000 0001 2248 6943Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Tsuda
- grid.69566.3a0000 0001 2248 6943Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
| | - Takaaki Akaike
- grid.69566.3a0000 0001 2248 6943Department of Environmental Health Sciences and Molecular Toxicology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- grid.69566.3a0000 0001 2248 6943Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan ,grid.69566.3a0000 0001 2248 6943Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan ,grid.69566.3a0000 0001 2248 6943Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan ,grid.69566.3a0000 0001 2248 6943Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Systemic immune-inflammation index could be associated with pseudophakic cystoid macular edema after an uneventful phacoemulsification surgery in patients without risk factors. BMC Ophthalmol 2022; 22:378. [PMID: 36131338 PMCID: PMC9494893 DOI: 10.1186/s12886-022-02606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the association between serum biomarkers and pseudophakic cystoid macular edema (PCME) in eyes without risk factors after uneventful phacoemulsification cataract surgery. METHODS This is a case-control study. Patients without risk factors and who developed clinically significant PCME after uncomplicated phacoemulsification surgery were enrolled in the study. The age- and sex-matched control group that had normal fundus examination findings and 10/10 visual acuity in the first week, first month and following postoperative control visits was randomly recruited from the same study cohort. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were obtained from the preoperative complete blood count (CBC) test and compared between the two groups. Linear regression analysis was used to assess the relationship between central macular thickness (CMT) and biomarkers. A binary logistic regression model was generated to evaluate the significance of the biomarkers in predicting PCME. The receiver operating characteristic (ROC) curves of the significant parameters in the logistic regression model were presented to detect the area under the curve (AUC), the cut-off point, the sensitivity and the specificity. RESULTS The study cohort included 5352 patients. Of these patients, 52 (0.97%) met the inclusion criteria, and 60 age- and sex-matched patients were recruited as the control group. PLR, NLR, and SII were significantly different between the two groups (p = 0.006, p = 0.002, p < 0.001, respectively). According to the linear regression analysis, SII was found to have a significant relationship with CMT (p < 0.001). Only SII was assessed as significant in the logistic regression model (p = 0.046). In the ROC curve, the AUC of SII was 0.709. The sensitivity and specificity of SII for PCME prediction were 65.38% and 75%, respectively, and the cut-off point was 433.70. CONCLUSION SII is associated with the occurrence of PCME in eyes without risk factors after uneventful phacoemulsification surgery. SII could be a useful tool to predict PCME in eyes without risk factors.
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Medin H, Dalby M, Kure ISH, Karabeg M, Drolsum L, Kristianslund O. Intraocular Inflammation in Eyes Operated for Late In-the-bag intraOcular lens dislocatioN (LION): A Randomized Clinical Trial. Am J Ophthalmol 2022; 238:66-74. [PMID: 34995522 DOI: 10.1016/j.ajo.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the intraocular inflammation after 2 surgical approaches for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel-group clinical trial. METHODS We randomly assigned 100 patients (100 eyes) referred to Oslo University Hospital (tertiary referral center) with late in-the-bag IOL dislocation into IOL repositioning by scleral suturing (n=49) or IOL exchange with retropupillary fixation of an iris-claw lens (n=51). Patients were examined before surgery and 2 weeks, 6 weeks, and 6 months after surgery. The main outcome measure was anterior chamber laser flare, measured with a laser flare meter as photon counts per millisecond (pc/ms). RESULTS Two weeks following surgery, median flare values were 28.9 pc/ms (range, 7.9-140) in the repositioning group and 31.6 pc/ms (range, 9.8-92.3) in the exchange group (P = .83). Flare levels were still elevated after 6 weeks with no difference between the groups (P = .93), whereas it decreased to baseline levels after 6 months. Six weeks following surgery, the central retinal thickness was similar (P = .97); cystoid macular edema (CME) was found in 4 and 5 patients, respectively (P = .85); and the mean best corrected visual acuity was 0.17 (95% CI 0.09, 0.25) and 0.21 (95% CI 0.09, 0.32) logarithm of the minimum angle of resolution, respectively (P = .61). CONCLUSIONS This study revealed similar levels of intraocular inflammation following IOL repositioning and IOL exchange. There was no significant difference regarding risk of CME and visual outcome. The prolonged elevation in postoperative flare indicates a possible requirement for an extended anti-inflammatory treatment period after these operations.
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Affiliation(s)
- Helle Medin
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway.
| | - Marius Dalby
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.)
| | | | - Mia Karabeg
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Liv Drolsum
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
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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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Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent. J Clin Med 2021; 10:jcm10102129. [PMID: 34069079 PMCID: PMC8157143 DOI: 10.3390/jcm10102129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.
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11
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Laser flare and cell photometry to measure inflammation after cataract surgery: a tool to predict the risk of cystoid macular edema. Int Ophthalmol 2021; 41:2293-2300. [PMID: 33745035 DOI: 10.1007/s10792-021-01779-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To review the current adoption of laser flare and cell photometry (LFCP) in the setting of modern cataract surgery to analyze inflammation aiming to identify evidence of a correlation between LFCP values and the risk of cystoid macular edema (CME) development. METHODS An extensive PubMed literature search was performed to review all the published studies investigating inflammation by LFCP after uncomplicated phacoemulsification. The following keywords were used: cataract surgery, cystoid macular edema, anterior chamber inflammation, laser flare, and cell photometry. RESULTS Seventy-eight original articles investigating inflammation by LFCP were selected. Macula alterations were searched in 12 (15%) trials, by optical coherence tomography or fluorescein angiography in 11 (14%) and 1 (1%) studies, respectively. Among them, 9 (12%) papers investigated the correlation between LFCP values and cystic changes to the macula: 7 (9%) and 2 (3%) studies identified a positive and negative correlation, respectively. Three (4%) papers did not perform any correlation analysis. CONCLUSION CME, as a consequence of uncontrolled postoperative inflammation, is a common cause for unfavorable visual outcomes following uncomplicated phacoemulsification with IOL implantation. After surgery, intraocular inflammation is generally assessed by qualitative methods. Although well-established and practical in uveitis, they are inadequate to detect the modest inflammatory response that usually occurs after uneventful phacoemulsification. LFCP correlate with the chance of macula alteration after surgery and higher the values higher the risk of CME. The quantitative analysis of intraocular inflammation by LFCP after cataract surgery might be a tool to predict the risk of pseudophakic CME.
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12
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Cagini C, Cerquaglia A, Pellegrino A, Iannone A, Lupidi M, Fiore T. Effect of preoperative topical nepafenac 0.1% on inflammatory response after uncomplicated cataract surgery in healthy subjects. Acta Ophthalmol 2021; 99:e70-e73. [PMID: 32558305 DOI: 10.1111/aos.14513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/19/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the effect of preoperative topical Nepafenac administration on anterior chamber flare after uneventful cataract surgery in healthy subjects. METHODS Prospective randomized clinical trial. Seventy-three eyes of 73 healthy patients undergoing routine cataract surgery were randomized to receive (group A) topical nepafenac (1 mg/ml) or not to receive (group B) 1 drop 3 times per day for 3 days before surgery. All eyes received the same postoperative anti-inflammatory therapy. Clinical outcome parameters such as best corrected visual acuity, intraocular pressure, retinal central foveal thickness and aqueous flare were recorded preoperatively, 1, 15, 30 and 60 days after surgery. RESULTS Three patients were excluded for poor compliance, and three patients were excluded or developing pseudophakic macular oedema during the follow-up. Both groups were comparable for age, gender, and showed similar BCVA, intraocular pressure and central macular thickness values preoperatively and during the entire follow-up (p > 0.01). Aqueous flare values showed a statistically increase in both groups respect to preoperative values through follow-up evaluations (p < 0.01), while values were significantly lower in group A than in group B 30 days after surgery (p < 0.01). CONCLUSION Preoperative administration of topical Nepafenac reduces the inflammatory response in healthy patients undergoing uncomplicated cataract surgery one month after surgery respect to non-treated group.
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Affiliation(s)
- Carlo Cagini
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
| | - Alessio Cerquaglia
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
| | - Adriana Pellegrino
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
| | - Alessia Iannone
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
| | - Tito Fiore
- Department of Biomedical and Surgical Sciences Ophthalmology Section University of Perugia Perugia Italy
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13
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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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14
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Kitazawa K, Sotozono C, Kinoshita S. Incidence and Management of Cystoid Macular Edema after Corneal Transplantation. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Ikegami Y, Takahashi M, Amino K. Evaluation of choroidal thickness, macular thickness, and aqueous flare after cataract surgery in patients with and without diabetes: a prospective randomized study. BMC Ophthalmol 2020; 20:102. [PMID: 32169068 PMCID: PMC7071624 DOI: 10.1186/s12886-020-01371-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In diabetic eyes, various choroidal abnormalities are noted in addition to changes in the retinal circulation, and the risk of increased aqueous flare and retinal thickening after cataract surgery is higher in diabetic eyes. Inflammation caused by surgery induces breakdown of the blood-retinal barrier and affects the retina, although the influence on the choroid is unknown. Several researchers have evaluated the choroidal thickness (CT) after cataract surgery in patients with diabetes; however, the results are inconsistent. The purpose of this study was to evaluate the influence of uneventful small-incision phacoemulsification cataract surgery on the subfoveal choroidal thickness (SCT), the central macular thickness (CMT), and aqueous flare in patients with diabetes. METHODS This study included 59 randomly selected eyes (33 eyes of patients with diabetes and 26 eyes of control patients without diabetes) undergoing small-incision cataract surgery. Among the diabetic eyes, 26 were without diabetic retinopathy, and the remaining eyes had non-proliferative diabetic retinopathy. Aqueous flare, CMT, and SCT measurements were performed before and at 1 week, 1 month, and 3 months after surgery. RESULTS The postoperative CMT continued to increase significantly until 3 months in both groups. Although the CMT was more in patients with diabetes than in patients without diabetes during the follow-up period, there was no significant difference between the two groups. The aqueous flare value increased until 3 months after surgery in both groups. Although the increase was significant at 3 months after surgery in patients with diabetes, the increase in controls was not significant. The aqueous flare values differed significantly between the two groups before and at 3 months after surgery. There was no significant within-group or between-group difference in pre- and postoperative SCT values. CONCLUSION In diabetic eyes with early stage of retinopathy, even small-incision cataract surgery can induce increased aqueous flare and macular thickening until 3 months, although there is no significant change in the choroidal thickness. Further studies are essential to evaluate choroidal changes after the cataract surgery in diabetic eyes.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Miyuki Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kana Amino
- Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan
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16
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Cagini C, Pellegrino A, Cerquaglia A, Iaccheri B, Lupidi M, Fiore T. Comparison of the Effect of Diclofenac 0.1% and Nepafenac 0.1% on Aqueous Flare in Patients Undergoing Cataract Surgery: A Prospective Randomized Study. Curr Eye Res 2020; 45:1089-1093. [DOI: 10.1080/02713683.2020.1725061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Carlo Cagini
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Adriana Pellegrino
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Alessio Cerquaglia
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
| | - Tito Fiore
- Department of Biomedical and Surgical Sciences, Ophthalmology Section, University of Perugia, Perugia, Italy
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17
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Lindholm J, Taipale C, Ylinen P, Tuuminen R. Perioperative subconjunctival triamcinolone acetonide injection for prevention of inflammation and macular oedema after cataract surgery. Acta Ophthalmol 2020; 98:36-42. [PMID: 31210019 DOI: 10.1111/aos.14175] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery. METHODS This prospective non-randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery. RESULTS Central retinal thickness (CRT) increased in DEX but not in TA-treated eyes at 7 days (+1.2 ± 20.1 μm and -9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and -3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and -5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and -0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed. CONCLUSIONS Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery.
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Affiliation(s)
- Juha‐Matti Lindholm
- 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
| | - Petteri Ylinen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Kymenlaakso Central Hospital Unit of Ophthalmology Kotka Finland
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18
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De Maria M, Iannetta D, Cimino L, Coassin M, Fontana L. Measuring Anterior Chamber Inflammation After Cataract Surgery: A Review of the Literature Focusing on the Correlation with Cystoid Macular Edema. Clin Ophthalmol 2020; 14:41-52. [PMID: 32021067 PMCID: PMC6957928 DOI: 10.2147/opth.s237405] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022] Open
Abstract
Cystoid macular edema (CME) is an infrequent, though potentially visually impairing, complication after uneventful cataract surgery. Rupture of the blood-aqueous barrier, with leakage of serum proteins into the aqueous humour, is the main pathogenic factor. However, only a few studies investigated the potential correlation between anterior chamber (AC) inflammation and the risk of cystoid macular changes occurring after surgery. This review aims to identify evidence of a correlation between AC inflammation and the risk of pseudophakic CME. One hundred eighty-seven prospective trials investigating AC inflammation after uncomplicated cataract surgery were identified. Methods of analysis of AC inflammation and the frequency of macular changes were recorded. In the majority (51%) of the studies, inflammation was assessed by clinical grading, followed by laser flare and cell photometry (LFCP) (42%) and aqueous humour sample (4%). Few studies (4%) adopted a combined LFCP and aqueous sample or clinical grading analysis. Sixteen (9%) studies investigated AC inflammation and macular changes by OCT (7%) or fluorescein angiography (2%). Correlation between the amount of postoperative AC inflammation and frequency of CME was documented in 7 studies, not confirmed in 2 studies, and not examined in the other 7. LFCP, more than the other methods of analysis, correlated with the frequency of CME postoperatively. Investigation of the relationship between AC inflammation and the risk of CME changes requires the adoption of quantitative methods of analysis of the inflammatory response after surgery. For this purpose, due to the low level of inflammation in the AC after uncomplicated cataract surgery, LFCP, more than subjective clinical grading, seems a more sensitive and reproducible method of measurement. Inflammation assessment after cataract surgery has a potential role in predicting the risk of CME development and may help to titrate the duration and intensity of treatment in relation to the surgical inflammatory response.
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Affiliation(s)
- Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine Ph.D. Programme, University of Modena and Reggio Emilia, Modena, Italy
| | - Danilo Iannetta
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luigi Fontana
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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19
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Taipale C, Holmström EJ, Ilveskoski L, Tuuminen R. Incidence of pseudophakic cystoid macular edema in eyes with and without pupil expansion device. Acta Ophthalmol 2019; 97:688-694. [PMID: 30575287 DOI: 10.1111/aos.14007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Novel pupil expansion devices are widely recognized for their intraoperative feasibility in safe small pupil cataract surgeries. To assess whether the use of pupil expansion devices affects recovery from cataract surgery. METHODS A post hoc analysis of five consecutive prospective randomized clinical trials. 536 eyes of 536 patients undergoing routine cataract surgery were analysed according to the use of pupil expansion device. Thirty-four eyes were operated with pupil expansion device and 502 eyes without. Clinical outcome parameters were recorded at 28 days and 3 months. RESULTS Patient age and gender distribution, and baseline clinical outcome parameters were comparable between study groups. Pseudoexfoliation syndrome, glaucoma and medication for benign prostatic hyperplasia were more frequently present; phacoemulsification energy was higher and operation time longer in eyes with pupil expansion device. At 28 days, aqueous flare increased by 12.0 ± 25.1 pu/mseconds and mean central subfield macular thickness by 16.2 ± 24.4 μm in eyes with pupil expansion device, when compared to 4.6 ± 14.8 pu/mseconds (p = 0.015) and 7.0 ± 33.9 μm (p = 0.064) in eyes without the device. At 3-month follow-up, clinically significant pseudophakic cystoid macular edema (PCME) was reported in 12% of eyes with pupil expansion device and in 2% of eyes without (p = 0.006). After adjusting for the presence of confounding factors, hazard for clinically significant PCME was greater in eyes with pupil expansion device than in those without (HR 5.41, 95% CI 1.35-21.71, p = 0.017). CONCLUSIONS The use of pupil expansion device may predispose eyes to increased risk of clinically significant PCME. Effective anti-inflammatory treatment and follow-up are warranted in eyes with pupil expansion device.
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Affiliation(s)
- Claudia Taipale
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Emil J. Holmström
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Transplantation Laboratory University of Helsinki Helsinki Finland
| | - Lotta Ilveskoski
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Unit of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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20
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Danni R, Viljanen A, Aaronson A, Tuuminen R. Preoperative anti-inflammatory treatment of diabetic patients does not improve recovery from cataract surgery when postoperatively treated with a combination of prednisolone acetate and nepafenac. Acta Ophthalmol 2019; 97:589-595. [PMID: 30620140 DOI: 10.1111/aos.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine preoperative anti-inflammatory treatment on recovery from cataract surgery in eyes of diabetic patients. METHODS A Prospective randomized clinical trial. One hundred and three eyes of 103 patients with diabetes undergoing routine cataract surgery were randomized (1:1) not to receive any preoperative anti-inflammatory medication or to receive preoperative topical anti-inflammatory medication with a combination of prednisolone acetate (10 mg/ml) and nepafenac (1 mg/ml). All eyes received postoperative anti-inflammatory combination therapy for 3 weeks. Recovery from surgery was recorded by a structured home questionnaire. Clinical outcome parameters were recorded at 28 days and 3 months. RESULTS Patient age and gender distribution, and all baseline ophthalmic and systemic parameters were comparable between the study groups. After surgery, conjunctival injection lasted 2.4 ± 1.7 days (mean ± SD) and irritation of the eye 3.3 ± 3.9 days in eyes without preoperative treatment, when compared to 1.6 ± 1.6 days (p = 0.067) and 2.4 ± 4.0 days (p = 0.431), respectively, in eyes with preoperative treatment. At 28 days, central subfield macular thickness (CSMT) increased 2.2 ± 20.2 μm in eyes without preoperative treatment, when compared 0.1 ± 25.2 μm (p = 0.670) in eyes with preoperative treatment. At 3 months, the respective CSMT change from baseline was -1.5 ± 26.9 μm and -3.4 ± 26.2 μm (p = 0.762). None of the eyes were reported with pseudophakic cystoid macular oedema (PCME) in either group. CONCLUSION Lack of preoperative anti-inflammatory treatment does not impair recovery from surgery or predispose diabetic patients to increased risk of PCME in eyes postoperatively treated with combination therapy of prednisolone acetate and nepafenac.
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Affiliation(s)
- Reeta Danni
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Antti Viljanen
- Medical Faculty University of Turku Turku Finland
- Medilaser and Coronaria Cor Group Oulu Finland
| | - Alexander Aaronson
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Unit of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Abstract
PURPOSE To study macular capillary changes and vessel density in acute pseudophakic cystoid macular edema (PCME) before and after treatment using optical coherence tomography angiography. METHODS Retrospective observational case-control study of seven consecutive patients (eight eyes) with PCME and eight age-matched control eyes imaged with optical coherence tomography angiography (RTVue XR Avanti; Optovue, Inc, Fremont, CA) using Projection Removal Artifacts software. Vessel density was calculated. RESULTS The mean time to diagnosis of PCME was 2.3 ± 0.9 months after surgery. At initial examination, the superficial capillary plexus pattern was near-normal in all PCME eyes, although it was attenuated in the deep capillary plexus. The mean vessel density of the superficial capillary plexus in PCME eyes was slightly but significantly lower than in control eyes (47.8 ± 3.8% vs. 52.9 ± 4.0%, P = 0.01), the difference being greater in the deep capillary plexus (44.1 ± 7.4% vs. 54.2 ± 3.2%, P = 0.007). After resolution of the edema, the deep capillary plexus completely recovered its normal pattern and the vessel density in both plexuses was no longer different from that observed in control eyes. CONCLUSION Macular vessel density after resolution of an acute PCME did not differ from that of normal control eyes in both the superficial capillary plexus and deep capillary plexus, unlike macular edema in retinal vaso-occlusive diseases.
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Pellegrini M, Sebastiani S, Giannaccare G, Campos EC. Intraocular inflammation after Ultrasound Cyclo Plasty for the treatment of glaucoma. Int J Ophthalmol 2019; 12:338-341. [PMID: 30809493 DOI: 10.18240/ijo.2019.02.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022] Open
Abstract
This is a prospective interventional clinical study evaluating intraocular inflammation developed after Ultrasound Cyclo Plasty (UCP) for the treatment of glaucoma. Eighteen eyes of 18 patients were treated with UCP second-generation probes (Eye OP1). After treatment, the mean intraocular pressure (IOP) significantly decreased from 26.8±7.2 to 18.8±6.1 mm Hg at day 1 and to 14.7±3.4 mm Hg at month 6 (all P<0.001). Mean laser flare-cell photometry value steeply increased after surgery from 12.1±7.5 to 64.1±53.9 ph/ms (P=0.001) at day 1, and then progressively decreased to respectively 60.6±49.7 at day 7, 43.5±38.5 at day 14 and 28.2±18.3 at month 1 (all P<0.05), returning at levels similar to baseline ones at month 3 and month 6 (respectively 16.7±6.2 and 12.8±10.2, both P>0.05). A significant negative correlation was found between postoperative increase of aqueous flare values and anterior chamber depth (R=-0.568, P=0.014). This timeframe may be considered reasonable for repeating UCP treatment, when required.
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Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Stefano Sebastiani
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Giuseppe Giannaccare
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
| | - Emilio C Campos
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, DIMES, University of Bologna, Bologna 40138, Italy
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Sudhir RR, Murthy PP, Tadepalli S, Murugan S, Padmanabhan P, Krishnamurthy A, Dickinson SL, Karthikeyan R, Kompella UB, Srinivas SP. Ocular Spot Fluorometer Equipped With a Lock-In Amplifier for Measurement of Aqueous Flare. Transl Vis Sci Technol 2018; 7:32. [PMID: 30619652 PMCID: PMC6314058 DOI: 10.1167/tvst.7.6.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/25/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose To evaluate a custom-made ocular fluorometer for detection of intensity of light scatter (ILS) from the anterior chamber (A/C) as an objective measure of aqueous flare. Methods The fluorometer, equipped with a lock-in amplifier, was employed in the scatter mode to detect ILS from A/C. Measurements were performed with two illumination slit widths of 0.5 and 0.25 mm. The axial resolution at these slit widths were 80 and 200 μm, respectively. Healthy and pseudophakic eyes, with grade 0 Standardization of Uveitis Nomenclature (SUN) score, were employed as control subjects. ILS was also recorded in a cohort of patients who had undergone phacoemulsification and showed grades 1+ or 2+ on postoperative days 1 and 4. Results The inter- and intraobserver variabilities in the measurement of ILS were not significant. In cataract patients, ILS was significantly higher on postoperative day 1 relative to healthy eyes. By day 4, ILS decreased significantly and was only marginally different from ILS in quiet pseudophakic eyes or healthy eyes. Eyes with higher SUN scores showed proportionately increased ILS. The receiver-operator characteristic analysis indicated no advantage in using the smaller slit width in discriminating ILS at different SUN scores although it provided higher axial resolution. Conclusions The lock-in–based spot fluorometer is reliable for measurement of ILS with high precision and accuracy.The measured ILS correlates linearly with SUN scores and can be used to provide a higher granularity for recording aqueous flare. Translational Relevance The instrument can be used in the clinical management of uveitis and drug development toward uveitis.
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Affiliation(s)
| | - P Pavani Murthy
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, India
| | - Sirisha Tadepalli
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Bengaluru, India
| | | | - Prema Padmanabhan
- Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, India
| | | | | | - R Karthikeyan
- Department of Electronics and Communication Engineering, Amrita School of Engineering, Amrita Vishwa Vidyapeetham, Bengaluru, India
| | - Uday B Kompella
- Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Amir-Asgari S, Hirnschall N, Findl O. Using continuous intraoperative optical coherence tomography to classify swirling lens fragments during cataract surgery and to predict their impact on corneal endothelial cell damage. J Cataract Refract Surg 2018; 42:1029-36. [PMID: 27492102 DOI: 10.1016/j.jcrs.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To quantify and classify swirling lens fragments during cataract surgery and record their impact on the corneal endothelium using continuous intraoperative optical coherence tomography (OCT). SETTING Vienna Institute for Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN Prospective case series. METHODS Patients scheduled for cataract surgery without other ophthalmologic comorbidities were included. During surgery, continuous OCT recordings were performed to measure and score swirling lens fragments that came into contact with the corneal endothelium. Endothelial cell density (ECD) was measured preoperatively and 1 month postoperatively. In addition, the central corneal thickness and aqueous flare were measured preoperatively and 1 hour, 1 day, and 1 month postoperatively. RESULTS Continuous intraoperative OCT video recordings showed 104 swirling lens fragments in 40 eyes that came into contact with the corneal endothelium. A mean of 2.6 lens fragments (range 0 to 6) that came into contact were observed per eye. Small fragments and fragments touching the center of the endothelium had a significantly greater effect on postoperative ECD than other fragment parameters. The predictive power of the fragment score on ECD was found to be moderate (r(2) = 0.6). CONCLUSIONS Small swirling lens fragments touching the center of the corneal endothelium had a significant influence on ECD. With the newly developed fragment score, it was possible to predict the operative endothelial cell loss. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Sahand Amir-Asgari
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Nino Hirnschall
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Oliver Findl
- From the Vienna Institute for Research in Ocular Surgery (Amir-Asgari, Hirnschall, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria, and the Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom.
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Wielders LH, Schouten JS, Winkens B, Nuijts RM. Reply. J Cataract Refract Surg 2018; 44:1164-1165. [DOI: 10.1016/j.jcrs.2018.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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Ylinen P, Holmström E, Laine I, Lindholm JM, Tuuminen R. Anti-inflammatory medication following cataract surgery: a randomized trial between preservative-free dexamethasone, diclofenac and their combination. Acta Ophthalmol 2018; 96:486-493. [PMID: 29369527 DOI: 10.1111/aos.13670] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the anti-inflammatory efficacy and tolerance between preservative-free dexamethasone (DEX) and diclofenac (DICL) eye drops, and their combination following cataract surgery. METHODS A randomized, double-blind, prospective single-centre study with 189 eyes of 180 patients undergoing routine cataract surgery. Laser flare meter measurement and spectral-domain optical coherence tomography imaging were conducted before surgery and at the 28-day postoperative visit. Clinical characteristics, surgical parameters and assessment of postoperative symptoms were recorded. RESULTS Preoperative flare was 9.0 ± 0.6 pu/ms and central retinal thickness (CRT) 269.6 ± 1.9 μm (mean ± SEM). On day 28, flare was 22.1 ± 2.9 pu/ms for DEX, 17.4 ± 2.5 pu/ms for DICL and 13.0 ± 1.6 pu/ms (p < 0.05) for their combination. Central retinal thickness (CRT) increase was 31.5 ± 8.8 μm for DEX, 6.0 ± 0.8 μm (p = 0.001) for DICL, and 3.5 ± 0.5 μm (p < 0.001) for their combination. The incidence of ocular symptoms related to the eye drops was 11% for DEX, 37% for DICL and 34% for their combination (p < 0.001). Clinically significant pseudophakic cystoid macular oedema (PCME) was observed in seven eyes which were all treated with DEX (p < 0.001). CONCLUSION Diclofenac (DICL), as well as the combination of DEX and DICL, were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME. Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.
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Affiliation(s)
- Petteri Ylinen
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Emil Holmström
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Transplantation Laboratory; University of Helsinki; Helsinki Finland
| | - Ilkka Laine
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Automation and Electrical Engineering; Aalto University; Helsinki Finland
| | - Juha-Matti Lindholm
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Kymenlaakso Central Hospital; Unit of Ophthalmology; Kotka Finland
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CHANGES IN CHOROIDAL THICKNESS IN CLINICALLY SIGNIFICANT PSEUDOPHAKIC CYSTOID MACULAR EDEMA. Retina 2018; 38:1629-1635. [DOI: 10.1097/iae.0000000000001747] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Re: Kitazawa et al.: Cystoid macular edema after Descemet's stripping automated endothelial keratoplasty (Ophthalmology. 2017;124:572-573). Ophthalmology 2017; 124:e86. [PMID: 29157434 DOI: 10.1016/j.ophtha.2017.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/24/2017] [Accepted: 06/22/2017] [Indexed: 11/23/2022] Open
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ANTERIOR CHAMBER FLARE DURING BEVACIZUMAB TREATMENT IN EYES WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2017; 36:2183-2190. [PMID: 27135211 DOI: 10.1097/iae.0000000000001061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To study the anterior chamber flare during bevacizumab treatment of exudative age-related macular degeneration. METHODS During a 2-year prospective follow-up, 50 patients recently diagnosed with exudative age-related macular degeneration were treated at once-a-month visits if subretinal or intraretinal fluid or a new hemorrhage was present in the lesion area. Flare was measured weekly during the first month and then monthly in both eyes. RESULTS Higher flare was associated with older age (P = 0.007, Linear Mixed Model), higher number of smoking pack-years (P = 0.019), macular cysts (P = 0.041), and pseudophakia (P = 0.003). The levels gradually increased during the follow-up (P < 0.0001) but less in the eyes with classic CNV (P = 0.011). Flare decreased during treatment-free periods lasting for at least two consecutive visits (P = 0.005). A peak in flare was observed 1 week after the first injection (P = 0.034, Wilcoxon signed rank test). In the fellow eyes, higher flare values in the beginning of the follow-up were associated with later conversion into exudative age-related macular degeneration (P = 0.015, Mann-Whitney U test). CONCLUSION Anterior chamber flare correlated poorly with the CNV activity. Higher levels may, however, precede or exist early in the process that leads to the development of exudative age-related macular degeneration.
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Sawa M. Laser flare-cell photometer: principle and significance in clinical and basic ophthalmology. Jpn J Ophthalmol 2016; 61:21-42. [PMID: 27888376 DOI: 10.1007/s10384-016-0488-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
A slit-lamp examination is an indispensable and essential clinical evaluation method in ophthalmology, but, it is qualitative subjective. To complement its weaknesses in making a quantitative evaluation of flare intensity and number of cells in the aqueous humor in the eye, we invented the laser flare-cell photometer in 1988. The instrument enables a non-invasive quantitative evaluation of flare intensity and number of cells in the aqueous with good accuracy and repeatability as well as maneuverability equal to slit-lamp microscopy. The instrument can elucidate the pathophysiology in the blood-aqueous barrier (BAB) function in a variety of ocular disorders. The accuracy of the instrument makes it possible to investigate not only the pathophysiology of intraocular disorders but also the effects of various drugs and surgical procedures in BAB. The instrument does not only lighten the burden on patients in clinical examinations and study but it also helps minimize the sacrifice of experimental animals and improves the reliability of the results by minimizing inter-individual variations through its good repeatability. Here I shall relate how the instrument has been applied to clinical and basic studies in ophthalmology and what novel knowledge its application contributed to pathophysiology in ophthalmology.
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Affiliation(s)
- Mitsuru Sawa
- Public Interest Incorporated Foundation Isshinkai, 3-37-8 Hongo, Bunkyo, Tokyo, 113-0033, Japan. .,Emeritus Professor, Nihon University, Tokyo, Japan.
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Intensified Early Postoperative Topical Steroids Do Not Influence Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery (Triple-DMEK). Cornea 2016; 35:1396-1400. [DOI: 10.1097/ico.0000000000000981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of Phacoemulsification Cataract Surgery with Low versus Standard Fluidic Settings and the Impact on Postoperative Parameters. Eur J Ophthalmol 2016; 27:39-44. [DOI: 10.5301/ejo.5000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/20/2022]
Abstract
Purpose To compare complications after cataract surgery using 2 different phacoemulsification fluidic settings. Methods One cataract surgeon (M.K.) performed phacoemulsification cataract surgery in one eye of 43 patients in this randomized prospective clinical study conducted at St. Erik Eye Hospital, Stockholm, Sweden. The patients were randomized to phacoemulsification with low fluidic settings in one group and standard fluidic settings in the other group. Corrected distance visual acuity (CDVA), central corneal thickness (CCT), endothelial cell density (ECD), anterior chamber flare, intraocular pressure (IOP), and macular thickness were measured preoperatively and postoperatively, with a final evaluation at 3 months. Surgical time, ultrasound energy, and amount of balanced saline solution used intraoperatively were recorded. Results Twenty-one patients were included in the group with standard settings and 22 patients were in the group with low settings. There were no significant differences between the groups in CDVA, CCT, flare, IOP, macular thickness, or ECD at 1 day, 3 weeks, or 3 months postoperatively. The surgical time was significantly (p = 0.009) longer and cumulative dissipated energy was significantly (p<0.001) higher in the group with low fluidic settings. Conclusions Although the surgical time and ECD were significantly higher in the group with low fluidic settings, there were no differences in the CCT, ECD, macular thickness, or inflammation postoperatively between the low and standard fluidic settings during phacoemulsification.
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Hwang HS, Ahn YJ, Lee HJ, Kim MS, Kim EC. Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery. Acta Ophthalmol 2016; 94:e189-94. [PMID: 25828946 DOI: 10.1111/aos.12716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/11/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the macular thickness and volume change, and inflammatory cytokine levels after cataract surgery performed using two different sizes of incision (microincision versus small incision). METHODS In this randomized, comparative clinical trial, 84 eyes with nuclear density from Grade 3-4 were randomly divided into two groups (microincision, 2.2 mm; and small incision, 2.75 mm). Forty-two patients underwent phacoemulsification with microincision coaxial cataract surgery and 42 patients underwent phacoemulsification with small incision coaxial cataract surgery. Clinical measurements included preoperative, 1-week, 1-month and 2-month postoperative best corrected visual acuity, central corneal thickness (CCT) and endothelial cell count. ELISA and RT-PCR were performed for IL-1β, IL-6, VEGF and PGE2 preoperatively and at 1 week postoperatively. RESULTS The percentage increase in CCT in the microincision group was significantly higher than that in the small incision group at 1 week after cataract surgery (p = 0.01). The increase in macular thickness in the microincision group was significantly higher than that in small incision group at 1 month after cataract operation (p = 0.04). Also, IL-1β, IL-6, VEGF and PGE2 concentrations and their expression ratio in the microincision group were significantly higher than those in the small incision group at 1 week after cataract surgery compared to the preoperative period (p < 0.05). CONCLUSIONS Phacoemulsification with microincision coaxial cataract surgery may increase the macular thickness compared to phacoemulsification with small incision coaxial cataract surgery. Blood-aqueous barrier breakdown may occur more frequently after microincision cataract surgery than after small incision cataract surgery.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology; Chuncheon Sacred Heart Hospital; College of Medicine; Hallym University; Chuncheon Korea
| | - Ye Jin Ahn
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Hee Jin Lee
- Institute of Clinical Medicine Research; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Man Soo Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Eun Chul Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
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Hoerster R, Stanzel TP, Bachmann BO, Siebelmann S, Felsch M, Cursiefen C. Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery. Am J Ophthalmol 2016; 163:174-179.e2. [PMID: 26701270 DOI: 10.1016/j.ajo.2015.12.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/26/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME). DESIGN Single-center comparative clinical study with historical controls. METHODS SETTING Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year. PATIENTS Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. Inclusion Criterion: Triple-DMEK surgery. EXCLUSION CRITERIA Prior retinal surgery, history of prior CME. INTERVENTIONS Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral-domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery. MAIN OUTCOME MEASURE Development of CME detected by macular SD OCT during 6 months postoperatively. RESULTS Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently (P = .003). Apart from the topical steroids during the first week, medical treatment was identical in both groups. CONCLUSIONS Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery.
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Affiliation(s)
- Robert Hoerster
- Department of Ophthalmology, University of Cologne, Cologne, Germany.
| | | | | | | | - Moritz Felsch
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Han SB, Kim M, Lee SJ, Yang HK. Pathophysiology of transient corneal edema and pseudophakic cystoid macular edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:203-4. [PMID: 26028950 PMCID: PMC4446562 DOI: 10.3341/kjo.2015.29.3.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Moosang Kim
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Seung-Jun Lee
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Do JR, Oh JH, Chuck RS, Park CY. Transient corneal edema is a predictive factor for pseudophakic cystoid macular edema after uncomplicated cataract surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:14-22. [PMID: 25646056 PMCID: PMC4309864 DOI: 10.3341/kjo.2015.29.1.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
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Affiliation(s)
- Jae Rock Do
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jong-Hyun Oh
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
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Lee TG, Kim JH, Chang YS, Kim CG, Kim JW. Factors influencing the exudation recurrence after cataract surgery in patients previously treated with anti-vascular endothelial growth factor for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2014; 252:1573-9. [PMID: 24723165 DOI: 10.1007/s00417-014-2624-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 03/10/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate factors influencing exudation recurrence following cataract surgery in patients already treated with anti-vascular endothelial growth factor (VEGF) agents for exudative age-related macular degeneration (AMD). METHODS A retrospective review of medical records was performed for patients who underwent cataract surgery and had been previously treated with anti-VEGF for exudative AMD. Visual acuity was examined before surgery and 1 and 6 months after surgery. The time between diagnosis and surgery, and the exudation-free period before surgery were examined and compared between patients who had exudation recurrence and those that did not. RESULTS Thirty-nine eyes of 39 patients were included in analyses. The logarithm of the minimum angle of resolution visual acuity was 1.02 ± 0.58 and had significantly improved 1 month (0.81 ± 0.62, P < 0.001) and 6 months (0.85 ± 0.64, P = 0.001) following surgery. Both the diagnosis-to-surgery period (P = 0.001) and the preoperative exudation-free period (P < 0.001) were significantly longer in patients without recurrence than in patients with recurrence. CONCLUSIONS Cataract surgery was beneficial in patients previously treated with anti-VEGF for exudative AMD. Our data suggests that cataract surgery should be performed after a sufficiently long exudation-free period to minimize exudation recurrence. But larger prospective studies are required to draw definitive clinical guidelines.
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Affiliation(s)
- Tae Gon Lee
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Ahn YJ, Kim EC. Change in Central Macular Thickness after 2.2-mm Microincision Coaxial versus 2.75-mm Small Incision Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.10.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ye Jin Ahn
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Eun Chul Kim
- Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Topical nonsteroidal anti-inflammatory drugs for macular edema. Mediators Inflamm 2013; 2013:476525. [PMID: 24227908 PMCID: PMC3818914 DOI: 10.1155/2013/476525] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/29/2013] [Indexed: 01/03/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are nowadays widely used in ophthalmology to reduce eye inflammation, pain, and cystoid macular edema associated with cataract surgery. Recently, new topical NSAIDs have been approved for topical ophthalmic use, allowing for greater drug penetration into the vitreous. Hence, new therapeutic effects can be achieved, such as reduction of exudation secondary to age-related macular degeneration or diabetic maculopathy. We provide an updated review on the clinical use of NSAIDs for retinal diseases, with a focus on the potential future applications.
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