1
|
Rhee MK, Zakher M, Najac M, Arias H, Jo J, Gorham R, Moadel K. Comparing Intracanalicular and Topical Steroid Use in Patients Undergoing Pterygium Surgery. Eye Contact Lens 2024; 50:183-188. [PMID: 38305478 PMCID: PMC10953680 DOI: 10.1097/icl.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The study received funding from Ocular Therapeutix, Inc., Bedford, MA.We undertook this study to compare the efficacy of intracanalicular dexamethasone 0.4 mg with topical prednisolone acetate (PA) 1% in controlling postoperative pain and inflammation in patients undergoing pterygium surgery. METHODS This was an open-label, prospective, interventional, nonrandomized comparative trial. Thirty patients were assigned to one of the following groups: Group A [intracanalicular insert of 0.4 mg dexamethasone placed into upper and lower puncta during the procedure, followed by at postoperative month 1 visit institution of topical PA 1% twice daily × 2 weeks then once daily × 2 weeks] or Group B [nonintervention group with institution on postoperative day 1 topical PA 1% every 2 hours × 2 weeks then four times per day × 2 weeks then twice daily × 2 weeks then once daily × 2 weeks]. RESULTS Fifteen cases and 15 controls were enrolled. There was no statistical difference in patient-reported pain or satisfaction between the case and control groups at 1 day; 1 week; and 1, 3, and 6 months postoperatively. There was no significant difference in time to an ocular hyperemia score of 0 between the two groups. There was no difference in the rate of corneal reepithelialization and recurrence rate (two controls). Nine eyes had transient ocular hypertension (seven cases and two controls). CONCLUSION Intracanalicular dexamethasone 0.4 mg may reduce the medication burden for patients who need prolonged postoperative steroid therapy as is routine in the setting of pterygium surgery. It is a safe and effective alternative to PA 1% drops alone for postoperative control of pain and inflammation in pterygium surgery.
Collapse
Affiliation(s)
- Michelle K. Rhee
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Meena Zakher
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Michael Najac
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Harold Arias
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Jace Jo
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Richard Gorham
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| | - Ken Moadel
- Department of Ophthalmology (M.K.R., J.J.), Icahn School of Medicine at Mount Sinai, New York, NY; Elmhurst Hospital (M.K.R.), Mount Sinai Services, New York, NY; Department of Ophthalmology (M.Z.), New York Eye and Ear Infirmary of Mount Sinai, New York, NY; Lewis Katz School of Medicine at Temple University (M.N.), Philadelphia, PA; Moadel Medicine (H.A., K.M.), New York, NY; and Ektropia Solutions LLC (R.G.), Laguna Beach, CA
| |
Collapse
|
2
|
Patel ED, Rhee MK. Surgical Techniques and Adjuvants for the Management of Pterygium. Eye Contact Lens 2022; 48:3-13. [PMID: 34686641 DOI: 10.1097/icl.0000000000000849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated review of surgical techniques and adjuvants for the management of pterygium. METHODS A literature search was conducted in PubMed for studies published since January 2011. "Pterygium surgery" and the MeSH term "Pterygium/surgery" was used. The results were filtered for randomized controlled trials in English, yielding 60 citations. RESULTS One study compared topical anesthetic agents. One study compared methods of corneal polishing of the corneoscleral bed after pterygium excision. Numerous studies evaluated the use of conjunctival autograft versus amniotic membrane, superior versus inferior conjunctival autograft, and conjunctival versus limbal-conjunctival autograft. Many studies evaluated graft fixation methods. Several studies evaluated the adjuvant use of mitomycin C, 5-fluorouracil, and bevacizumab. A few studies evaluated the adjuvant use of steroids. Eleven studies evaluated various methods of postoperative management. CONCLUSIONS Current evidence supports pterygium excision with conjunctival autograft fixation using fibrin glue, followed by patching until the first postoperative visit. Surgical adjuvants and postoperative use of artificial tears and topical cyclosporine 0.05% may further reduce recurrence. Postoperative use of topical steroids is highly variable because there is no consensus regarding the optimal dose, frequency, and duration of treatment.
Collapse
Affiliation(s)
- Ekta D Patel
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | |
Collapse
|