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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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Bill C, Kassumeh S, Hilterhaus C, Tersi N, Speidel AJ, Ohlmann A, Priglinger S, Priglinger C, Wolf A, Wertheimer CM. Conditions for modifying intraocular lenses as drug carriers for methotrexate using poly (lactic-co-glycolic acid). Eur J Ophthalmol 2024:11206721241239717. [PMID: 38494950 DOI: 10.1177/11206721241239717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The intraocular lens (IOL) can be used as a slow-release drug carrier in cataract surgery to alleviate posterior capsular opacification (PCO). The following is a systematic development of an IOL using methotrexate and the solvent casting process with poly (lactic-co-glycolic acid) (PLGA) as a carrier polymer. METHODS Different solvents for PLGA and methotrexate were tested for dissolution properties and possible damage to the IOL. The required biological concentration of methotrexate was determined in human capsular bags implanted with an IOL. To detect fibrosis, α-SMA, f-actin, and fibronectin were labelled by immunofluorescence staining. Cell proliferation and extracellular matrix contraction were observed in a lens epithelial cell line (FHL-124). Finally, the IOL was designed, and an ocular pharmacokinetic model was used to measure drug release. RESULTS Solvent mixtures were found to allow coating of the IOL with drug and PLGA without damaging it. PCO in the capsular bag model was inhibited above 1 μM methotrexate (p = 0.02). Proliferation in FHL-124 was significantly reduced above a concentration of 10 nM (p = 0.04) and matrix contraction at 100 nM (p = 0.02). The release profile showed a steady state within therapeutic range. CONCLUSION After determination of the required physicochemical manufacturing conditions, a drug releasing IOL was designed. A favourable release profile in an ocular pharmacokinetics model could be shown.
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Affiliation(s)
- Clarissa Bill
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Hilterhaus
- Department of Ophthalmology, University Hospital, University of Ulm, Ulm, Germany
| | - Natalie Tersi
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Arne J Speidel
- Department of Ophthalmology, University Hospital, University of Ulm, Ulm, Germany
| | - Andreas Ohlmann
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | | | - Claudia Priglinger
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
- Department of Ophthalmology, University Hospital, University of Ulm, Ulm, Germany
| | - Christian M Wertheimer
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
- Department of Ophthalmology, University Hospital, University of Ulm, Ulm, Germany
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Awidi AA, Chang DF, Riaz KM, Li X, LaBorwit S, Zebardast N, Srikumaran D, Prescott CR, Daoud YJ, Woreta FA. Anti-inflammatory medication use after cataract surgery: online survey of practice patterns. J Cataract Refract Surg 2024; 50:224-229. [PMID: 38381616 PMCID: PMC10878440 DOI: 10.1097/j.jcrs.0000000000001341] [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: 07/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine current prescribing patterns for topical or intraocular/periocular anti-inflammatory medications (AIMs) after routine cataract surgery. SETTING kera-net online members. DESIGN Cross-sectional survey. METHODS An online survey was distributed to subscribers of kera-net, a global online platform sponsored by the Cornea Society. Questions were asked regarding the use of topical or intraocular/periocular AIM after cataract surgery and types of medications prescribed. RESULTS Of 217 surgeon respondents (23% response rate), 171 (79%) practiced in the United States and 171 (79%) were cornea subspecialists. Most of the respondents (n = 196, 97%) prescribed topical corticosteroids after routine cataract surgery. The most frequently prescribed were prednisolone acetate (n = 162, 83%), followed by dexamethasone (n = 26, 13%), difluprednate (n = 24, 12%), and loteprednol etabonate (n = 13, 7%). Corticosteroids comprised (n = 40, 32%) of total intraocular/periocular injections, with triamcinolone acetonide 10 or 40 mg (n = 19, 47.5%) most commonly used. 23 surgeons (58%) who utilized intraocular/periocular corticosteroids also prescribed topical corticosteroids. Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 148 surgeons (73%). CONCLUSIONS Most surgeons prescribed topical AIM after routine cataract surgery. Many surgeons injected intraocular or periocular AIM while prescribing topical AIM. The diversity of practice patterns may reflect the lack of clear evidence-based guidelines.
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Affiliation(s)
- Abdelhalim A. Awidi
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - David F. Chang
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Kamran M. Riaz
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Ximin Li
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Scott LaBorwit
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Nazlee Zebardast
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Divya Srikumaran
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Christina R. Prescott
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Yassine J. Daoud
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Fasika A. Woreta
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
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Mikropoulos DG, Kymionis GD, Chatzea MS, Xanthopoulou K, Ageladarakis PK, Voudouragkaki IC, Konstas AG. Acute Corneal Melting Induced by the Concomitant Use of a Non-steroidal Anti-inflammatory Agent with an Antiseptic Eye Drop. Ophthalmol Ther 2024; 13:645-649. [PMID: 38127195 PMCID: PMC10787727 DOI: 10.1007/s40123-023-00864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME). CASE REPORT A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2 days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1 month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly. CONCLUSIONS Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.
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Affiliation(s)
- Dimitrios G Mikropoulos
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Georgios D Kymionis
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina S Chatzea
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kassandra Xanthopoulou
- First Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis K Ageladarakis
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Irini C Voudouragkaki
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece
| | - Anastasios G Konstas
- First University Department of Ophthalmology, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 546 36, Thessaloniki, Greece.
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You R, Han Y. A meta-analysis of topical Ketorolac's effect on surgical site wound healing post-cataract surgery. Int Wound J 2024; 21:e14661. [PMID: 38272819 PMCID: PMC10789915 DOI: 10.1111/iwj.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/27/2024] Open
Abstract
This meta-analysis evaluates the impact of topical ketorolac on surgical site wound healing and scar formation after cataract surgery. A thorough literature search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified eight relevant studies from 2348 articles. The selected studies were analysed for wound healing efficacy, using the redness, edema, ecchymosis, discharge and approximation (REEDA) scale, and scar formation, assessed by the Manchester scar scale (MSS). Results indicated that ketorolac significantly improved wound healing, with lower REEDA scores 1 week post-surgery (I2 = 97%; Random: standardised mean difference (SMD): -10.93, 95% CI: -13.85 to -8.00, p < 0.01), and reduced scar formation, evidenced by lower MSS scores 3 months post-surgery (I2 = 74%; Random: SMD: -9.67, 95% CI: -11.03 to -8.30, p < 0.01). The findings suggest that topical ketorolac is beneficial in post-cataract surgery care, enhancing wound healing and reducing scarring.
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Affiliation(s)
- Ran You
- Ophthalmology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Yu Han
- OphthalmologyBeijing Aier Eye HospitalBeijingChina
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Shoman NA, Gebreel RM, El-Nabarawi MA, Attia A. Optimization of hyaluronan-enriched cubosomes for bromfenac delivery enhancing corneal permeation: characterization, ex vivo, and in vivo evaluation. Drug Deliv 2023; 30:2162162. [PMID: 36587627 PMCID: PMC9943252 DOI: 10.1080/10717544.2022.2162162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To design and evaluate hyaluronan-based cubosomes loaded with bromfenac sodium (BS) for ocular application to enhance the corneal permeation and retention in pterygium and cataract treatment. BS-loaded cubosomes were prepared by the emulsification method, employing 23 full factorial design using Design-Expert® software. Glycerol monoolein (GMO) and poloxamer 407 (P407) as lipid phase and polyvinyl alcohol (PVA) as stabilizer were the used ingredients. The optimized formulation (OBC; containing GMO (7% w/w), P407 (0.7% w/w) and PVA (2.5% w/w)) was further evaluated. OBC had an entrapment efficiency of 61.66 ± 1.01%, a zeta potential of -30.80 ± 0.61 mV, a mean particle size of 149.30 ± 15.24 nm and a polydispersity index of 0.21 ± 0.02. Transmission electron microscopy confirmed its cubic shape and excellent dispersibility. OBC exhibited high stability and no ocular irritation that was ensured by histopathology. Ex vivo permeation study showed a significant increase in drug deposition and permeability parameters through goat cornea, besides, confocal laser microscopy established the superior permeation capability of OBC, as compared to drug solution. In vivo pharmacokinetics in aqueous humor indicated higher AUC0-tlast (18.88 µg.h/mL) and mean residence time (3.16 h) of OBC when compared to the marketed eye drops (7.93 µg.h/mL and 1.97 h, respectively). Accordingly, hyaluronan-enriched cubosomes can be regarded as a promising carrier for safe and effective topical ocular delivery.
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Affiliation(s)
- Nabil A. Shoman
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt
| | - Rana M. Gebreel
- Department of Pharmaceutics, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt
| | - Mohamed A. El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Alshaimaa Attia
- Department of Industrial Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt,CONTACT Alshaimaa Attia Department of Industrial Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt
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Ahmadyar G, Carlson JJ, Kimura A, Alobaidi A, Hallak J, Hansen RN. Real-world treatment patterns and economic burden of post-cataract macular edema. BMC Ophthalmol 2023; 23:380. [PMID: 37723463 PMCID: PMC10506304 DOI: 10.1186/s12886-023-03113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Post-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME. METHODS This retrospective claims analysis identified patients from the IBM® MarketScan® Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models. RESULTS Treatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 [30%]), topical nonsteroidal anti-inflammatory drug drops (321 [27%]), and intraocular or periocular injectable steroids (189 [15%]). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7-6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8-3.2), adding $371 in total cost (95% CI: $332 - $410). CONCLUSIONS PCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.
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Affiliation(s)
- Gina Ahmadyar
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA.
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA.
| | - Josh J Carlson
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
| | - Alan Kimura
- Colorado Retina Associates, 255 S. Routt St., Suite 200, 80228, Lakewood, CO, USA
| | - Ali Alobaidi
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Joelle Hallak
- AbbVie Inc, 2525 DuPont Drive, 92612, Irvine, CA, USA
| | - Ryan N Hansen
- School of Pharmacy, University of Washington, 1956 NE Pacific St, HSB H-362, 98195, Seattle, WA, USA
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8
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Mohammad-Rabei H, Sabbaghi H, Emamverdi M, Karimi S, Ramezani A, Nikkhah H, Kheiri B, Yaseri M, Sheibani K, Bahreini R. The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients. BMC Ophthalmol 2023; 23:320. [PMID: 37452330 PMCID: PMC10347851 DOI: 10.1186/s12886-023-03077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo. METHODS A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls. RESULTS 49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all). CONCLUSION Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients. TRAIL REGISTRATION The study protocol was registered into www. CLINICALTRIAL gov with the RCT registration number NCT03551808. (2018/06/11 ) CLINICAL TRIAL REGISTRATION NUMBER: NCT03551808.
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Affiliation(s)
- Hossein Mohammad-Rabei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Opposite to Bou-Ali Hospital, Damavand Ave., Tehran, Iran
| | - Mehdi Emamverdi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfe Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- School of Public Health and Public Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Razieh Bahreini
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Opposite to Bou-Ali Hospital, Damavand Ave., Tehran, Iran.
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Heath M, McDonald MC, Murphy DA, Shah SV, Shah S, Ding K, Riaz KM. Fill levels, cost comparisons, and expulsion force requirements of commonly used topical ophthalmic nonsteroidal anti-inflammatory drugs. J Cataract Refract Surg 2023; 49:747-753. [PMID: 36853852 DOI: 10.1097/j.jcrs.0000000000001177] [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: 12/11/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) commonly perioperatively in the United States. SETTING Tertiary care academic medical center. DESIGN Prospective laboratory investigation. METHODS 8 commercially available NSAIDs (3 branded, 5 generic) were tested: branded bromfenac 0.07%, generic bromfenac 0.09%, diclofenac 0.1%, flurbiprofen 0.03%, generic ketorolac 0.5%, branded ketorolac 0.5%, ketorolac 0.47%, and branded nepafenac 0.3%. 10 bottles of each medication were tested, with an additional bottle tested for expulsion force requirements. A double-blinded method was used to measure the actual bottle fill volume and number of drops per bottle. The total cost per drop was calculated using published cash prices. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using the Kruskal-Wallis test, followed by pairwise comparisons with the Dwass, Steel, Critchlow-Fligner Method. RESULTS 2 branded NSAIDs (bromfenac and nepafenac) had slightly lower-than-sticker volumes while generics other than ketorolac had higher-than-sticker volumes. Diclofenac and branded bromfenac had the highest and lowest adjusted number of drops respectively. Generic bromfenac and generic ketorolac had the highest and lowest adjusted volume compared with sticker volume respectively. Branded bromfenac was the most expensive medication, while generic diclofenac was the least expensive. Force expulsion requirements varied significantly among generic and branded NSAIDs. CONCLUSIONS Volume fill levels, patient-incurred costs, and expulsion force requirements per bottle of topical NSAID medications vary significantly. Surgeons may wish to consider these factors when deciding how best to use these medications perioperatively.
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Affiliation(s)
- Michael Heath
- From the Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Heath, McDonald, Murphy, Riaz); Oklahoma School of Science and Mathematics, Oklahoma City, Oklahoma (S.V. Shah, S. Shah); Hudson College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma (Ding)
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10
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Ahmadzadeh A, Schmidt BS, Bach-Holm D, Kessel L. Early Inflammation Control After Trabeculectomy by Steroid and Non-steroidal Eye Drops: A Randomized Controlled Trial. Ophthalmol Ther 2023; 12:969-984. [PMID: 36602718 PMCID: PMC10011236 DOI: 10.1007/s40123-022-00636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION To compare the effect of three different anti-inflammatory regimens consisting of preservative-free dexamethasone (DEX), diclofenac (DICLO) eye drops, and their combination (DEX + DICLO) following trabeculectomy on early postoperative inflammation. METHODS A prospective randomized controlled trial. Sixty-nine patients undergoing trabeculectomy were randomized to receive either postoperative treatment with topical DEX (n = 23), topical DICLO (n = 23), or a combination of topical DEX and topical DICLO (n = 23) after trabeculectomy. The primary outcome was the anterior chamber flare measurement in the first 3 months postoperatively. Secondary outcomes included intraocular pressure, central corneal thickness, conjunctival injection, and number of cells in the anterior chamber from baseline to 3 months postoperatively. RESULTS Anterior chamber flare reached a maximum 1 day after trabeculectomy with an increase of 55% (95% CI 37-73%) for DEX, 64% (95% CI 47-82%) for DICLO, and 57% (95% CI 39-75%) for DEX + DICLO and returned to near pre-operative values 6 weeks after surgery. There were no significant differences in anterior chamber flare [effect size for DICLO: 0.16 (95% CI - 4.3 to 4.6), effect size for DEX + DICLO: 0.09 (95% CI - 4.1 to 4.3)], intraocular pressure, central corneal thickness, conjunctival injection, or number of cells in the anterior chamber between DEX, DICLO, or DEX + DICLO groups. CONCLUSION We found that topical diclofenac was not statistically different from topical dexamethasone in controlling early postoperative inflammation after trabeculectomy, while combining diclofenac and dexamethasone offered no added anti-inflammatory control compared to dexamethasone alone. TRIAL REGISTRATION www. CLINICALTRIALS gov (NCT04054830).
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Affiliation(s)
- Afrouz Ahmadzadeh
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.
| | | | - Daniella Bach-Holm
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital-Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Nguyen A, Kolluru A, Beglarian T. Dry eye disease: A review of anti-inflammatory therapies. Taiwan J Ophthalmol 2023; 13:3-12. [DOI: 10.4103/2211-5056.369606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 02/15/2023] Open
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12
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Visco DM. Comparison of postcataract surgery anti-inflammatory regimens on the incidence of cystoid macular edema, iritis, pain, and photophobia. J Cataract Refract Surg 2023; 49:44-49. [PMID: 35862832 DOI: 10.1097/j.jcrs.0000000000001022] [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: 11/02/2021] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare postcataract surgery anti-inflammatory regimens of intracanalicular dexamethasone insert and topical bromfenac on the incidence of cystoid macular edema (CME), iritis, pain, and photophobia. SETTING Eyes of York Cataract & Laser Center, York, Pennsylvania. DESIGN Retrospective chart review. METHODS Case records of 647 consecutive patients (1001 eyes) who underwent cataract surgery and received dexamethasone intracanalicular insert 0.4 mg (Group 1; 482 eyes) or topical nonsteroidal anti-inflammatory drug (NSAID) (bromfenac 0.075% 2 times a day) for 4 weeks postoperatively (Group 2; 519 eyes) were included. Both groups received intracameral moxifloxacin and phenylephrine/ketorolac. Patients with prior CME, vitreomacular traction, combined cataract/glaucoma surgery, and medication protocols different from those examined in this study were excluded. RESULTS Compared with the dexamethasone insert group, the topical NSAID group had a significantly lower incidence of CME (0.4% [2/519] vs 3.9% [19/482], P < .001) and photophobia (1.9% [10/519] vs 4.8% [23/482], P = .012). The incidence of breakthrough iritis (3.5% [18/519] vs 5.6% [27/482], P = .104) and pain also trended lower (4.0% [21/519] vs 5.4% [26/482], P = .314) in the topical NSAID group. CONCLUSIONS Topical NSAIDs were found to be more effective in controlling CME, pain, iritis, and photophobia after cataract surgery compared with the intracanalicular dexamethasone insert in the presence of intracameral phenylephrine/ketorolac.
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Affiliation(s)
- Denise M Visco
- From the Eyes of York Cataract & Laser Center, York, Pennsylvania
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13
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Parametric Drug Release Optimization of Anti-Inflammatory Drugs by Gold Nanoparticles for Topically Applied Ocular Therapy. Int J Mol Sci 2022; 23:ijms232416191. [PMID: 36555830 PMCID: PMC9786640 DOI: 10.3390/ijms232416191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Eye drops represent 90% of all currently used ophthalmic treatments. Only 0.02% of therapeutic molecules contained in eye drops reach the eye anterior chamber despite their high concentration. The tear film efficiently protects the cornea, reducing access to the target. Thereby, the increase in the drug bioavailability and efficiency must come from the mucoadhesion optimization of the drug delivery system. The gold nanoparticles, used as a drug delivery system in this study, already showcased ultrastable and mucoadhesive properties. The goal was to study the gold nanoparticles' ability to release two specific ophthalmic drugs, flurbiprofen and ketorolac. The parameters of interest were those involving the loading conditions, the gold nanoparticles properties, and the release experimental conditions. The drug release was measured using an in vitro model based on dialysis bags coupled with UV-visible spectroscopy. Gold nanoparticles showed an ability to release different molecules, whether hydrophobic or hydrophilic, in passive or active drug release environments. Based on these preliminary results, gold nanoparticles could represent a promising drug delivery system for ketorolac and flurbiprofen when topically applied through eye drops.
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14
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Gessa-Sorroche M, Kanclerz P, Alio J. Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:149-160. [PMID: 35248396 DOI: 10.1016/j.oftale.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/20/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.
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Affiliation(s)
- M Gessa-Sorroche
- Hospital Universitario Virgen Macarena, Grupo Miranza, Sevilla, Spain
| | | | - J Alio
- Vissum Grupo Miranza, Alicante, Spain.
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15
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Wang Y, Shen F, Sun W, Wang Q, Zhao X. Bandage contact lens soaked in 0.1% diclofenac to relieve early postoperative pain and foreign body sensation after transepithelial photorefractive keratectomy. Eur J Ophthalmol 2022; 32:3321-3327. [PMID: 35196147 DOI: 10.1177/11206721221082301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the effects of a bandage contact lens immersed in 0.1% diclofenac on pain management for patients undergoing transepithelial photorefractive keratectomy (TPRK). METHODS In a prospective, comparative, contralateral, randomized, double-masked study, we assessed a total of 51 patients. The eyes of each patient were randomly divided into two groups. After TPRK, a normal soft bandage contact lens was placed on one eye as the control group, and a bandage contact lens soaked in diclofenac was placed on the other eye as the experimental group. When the bandage contact lens was not removed, postoperative pain and other ocular discomforts were compared at 2, 18, and 24 h and 2, 3, 4, and 5 postoperative days. Patients were then examined after 1 month. Visual acuity and subepithelial haze were also evaluated. RESULTS The mean pain score was 2.69 ± 1.96 in the control group, which was significantly higher than that in the experimental group, which received the diclofenac-soaked bandage contact lens at 2 postoperative hours. The statistical difference between the two groups' mean foreign body sensation at 2 postoperative hours was detected (p = 0.035). No differences were detected between the two groups' subepithelial haze scores or visual acuity. CONCLUSION A bandage contact lens soaked in 0.1% diclofenac solution can be used as a potential drug-delivery system to relieve early postoperative pain and foreign body sensation after TPRK.
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Affiliation(s)
- Yuan Wang
- 150163Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou 325027, Zhejiang, China.,Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Fei Shen
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Weiyang Sun
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Qinmei Wang
- 150163Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou 325027, Zhejiang, China.,Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Xiangyang Zhao
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
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Comparative evaluation of once-daily and twice-daily dosing of topical bromfenac 0.09%: aqueous pharmacokinetics and clinical efficacy study. J Cataract Refract Surg 2021; 47:1115-1121. [PMID: 34468447 DOI: 10.1097/j.jcrs.0000000000000589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate aqueous pharmacokinetics of topical bromfenac 0.09% and compare clinical outcomes of once- and twice-daily dosing in phacoemulsification. SETTING Dr. R.P. Center for Ophthalmic Sciences, AIIMS, New Delhi, India. DESIGN Prospective interventional study. METHODS In phase I, single-drop aqueous pharmacokinetics of topical bromfenac was estimated at 15 minutes, 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours, and 24 hours using liquid chromatography mass spectrometry in 60 eyes. In phase II, 45 eyes undergoing phacoemulsification were enrolled: group I (control, n = 15), group II (once-daily bromfenac, n = 14), and group III (twice-daily bromfenac, n = 16). Intraoperative pupillary miosis, postoperative anterior chamber (AC) flare, Summed Ocular Inflammation Score (SOIS), central macular thickness (CMT), and pain scores were assessed. Follow-up was performed at 1 day, 7 days, 28 days, and 90 days postoperatively. RESULTS Half-life of topical bromfenac was 3.6 hours, mean residence time 5.5 hours, and peak concentration (63.73 ng/mL) achieved after 2 hours. Aqueous concentration was more than inhibitory concentration (IC50) at 12 hours but not at 24 hours. Cumulative effect was observed with repeated dosing with aqueous levels more than IC50 in once-daily and twice-daily groups at 5 days. Significant intraoperative miosis was observed in group I. Pain score, AC flare, and SOIS were significantly more in group I (P < .001) and comparable in groups II and III at all timepoints. CMT was comparable in all groups; no case developed cystoid macular edema. CONCLUSIONS Single-dose topical bromfenac did not maintain therapeutic aqueous concentration over 24 hours; however, cumulative effect was observed with repeated dosing. Clinical efficacy of once-daily and twice-daily dosing was comparable.
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Bezatis A, Georgou I, Dedes J, Theodossiadis P, Chatziralli I. Nepafenac in cataract surgery. Clin Exp Optom 2021; 105:263-267. [PMID: 34210237 DOI: 10.1080/08164622.2021.1945412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in routine cataract surgery has been established since decades. Topical NSAIDs have been shown to reduce postoperative ocular inflammation and pain, preserve intraoperative mydriasis, and reduce the risk of postoperative cystoid macular oedema, whilst carrying a very low side-effect profile. Nepafenac is one of the currently available topical NSAIDs. The studies have shown that is has a high ocular penetration, allowing for potentially better results than other NSAIDs. This review gathers the current literature on the role of nepafenac in cataract surgery aiming to help surgeons maximise the benefits of its use to achieve improved surgical outcomes.
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Affiliation(s)
- Athanasios Bezatis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Georgou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Dedes
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Shorstein NH, Carolan J, Liu L, Alexeeff SE, Amsden LB, Herrinton LJ. Visual outcomes after cataract surgery: topical nonsteroidal anti-inflammatory drug prophylaxis compared with prednisolone. J Cataract Refract Surg 2021; 47:870-877. [PMID: 33315744 DOI: 10.1097/j.jcrs.0000000000000542] [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: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare visual outcomes in patients without a history of macular edema after phacoemulsification using combination topical nonsteroidal anti-inflammatory drug plus prednisolone with prednisolone alone. SETTING Kaiser Permanente Northern California, USA. DESIGN Retrospective cohort study. METHODS Information was obtained from the electronic health record. The first measure of corrected distance visual acuity (CDVA) recorded during the period 3 weeks to 1 year after phacoemulsification was obtained. Confounding factors and clustering of eyes within patients were adjusted using linear mixed effects regression models for the continuous outcome of CDVA improvement and general estimating equations for the dichotomous outcome of 20/20 or better vs 20/25 or worse. RESULTS The study included 62 700 health plan members of whom 26,309 (42%) used topical prednisolone alone, whereas 36,391 (58%) used combination treatment. The mean within-person change in CDVA from the preoperative measurement to the postoperative measurement was the same (-0.43 logMAR) for patients in the 2 groups. However, the group that received combination treatment was somewhat more likely to achieve CDVA of 20/20 or better (odds ratio 1.24 with 95% CI, 1.20-1.28). CONCLUSIONS In this large study of cataract surgery patients, a small statistically significant association of combination treatment compared with prednisolone alone was observed.
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Affiliation(s)
- Neal H Shorstein
- From the Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California (Shorstein); Department of Ophthalmology, Kaiser Permanente San Rafael, California (Carolan); Division of Research, Kaiser Permanente Northern California, Oakland, California (Liu, Alexeeff, Amsden, Herrinton)
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Oli A, Waikar S. Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema. Indian J Ophthalmol 2021; 69:765-767. [PMID: 33595522 PMCID: PMC7942133 DOI: 10.4103/ijo.ijo_1464_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months.
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Affiliation(s)
- Avadhesh Oli
- Post Graduate Department of Ophthalmology, INHS Asvini, Colaba Mumbai, Maharashtra, India
| | - Shrikant Waikar
- Post Graduate Department of Ophthalmology, INHS Asvini, Colaba Mumbai, Maharashtra, India
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20
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Topete A, Barahona I, Santos LF, Pinto CA, Saraiva JA, Paula Serro A, Saramago B. The effects of addition of functional monomers and molecular imprinting on dual drug release from intraocular lens material. Int J Pharm 2021; 600:120513. [PMID: 33766642 DOI: 10.1016/j.ijpharm.2021.120513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
Although cataract surgery is considered a safe procedure, post-surgery complications such as endophthalmitis and ocular inflammation, may occur. To prevent this, antibiotics and anti-inflammatories are prescribed in the form of eye drops during the post-operatory period, but they lead to a low drug bioavailability in target tissues. The objective of this work is to develop an intraocular lens (IOL) material to deliver simultaneously one antibiotic, moxifloxacin (MXF), and one anti-inflammatory, diclofenac (DFN), in therapeutic concentrations to prevent both complications. The IOL material was modified through the incorporation of functional monomers, as well as molecular imprinting with both drugs using the same functional monomers, namely acrylic acid (AA), methacrylic acid (MAA), 4-vinylpiridine (4-VP) and a combination of MAA + 4-VP. The best results were obtained with MAA. Molecular imprinting did not influence the drug release, except with AA. Application of a mathematical model predicted that the released MXF and DFN concentrations would stay above the pre-determined MIC of S. aureus and S. epidermidis and the minimum values of IC50 of COX-1 and COX-2, for 9 and 14 days, respectively. Antibacterial tests showed that the released antibiotic remained active. The physical properties of the drug-loaded MAA-hydrogel remained adequate. The developed system proved to be non-irritant and non-cytotoxic.
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Affiliation(s)
- Ana Topete
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Isabel Barahona
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| | - Luís F Santos
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Carlos A Pinto
- QOPNA & LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Jorge A Saraiva
- QOPNA & LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Ana Paula Serro
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal.
| | - Benilde Saramago
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
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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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Morgan-Warren PJ, Morarji JB. Trends in licence approvals for ophthalmic medicines in the United Kingdom. Eye (Lond) 2020; 34:1856-1865. [PMID: 31900439 PMCID: PMC7608198 DOI: 10.1038/s41433-019-0758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/09/2022] Open
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Topete A, Tang J, Ding X, Filipe HP, Saraiva JA, Serro AP, Lin Q, Saramago B. Dual drug delivery from hydrophobic and hydrophilic intraocular lenses: in-vitro and in-vivo studies. J Control Release 2020; 326:245-255. [DOI: 10.1016/j.jconrel.2020.07.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
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Ocular surgery after herpes simplex and herpes zoster keratitis. Int Ophthalmol 2020; 40:3599-3612. [PMID: 32910331 DOI: 10.1007/s10792-020-01539-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/25/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The recurrence of herpetic stromal keratitis (HSK) and herpes zoster ophthalmicus (HZO) has been reported after a variety of ocular surgeries. The aim of this study was to review the evidence on the preventive methods employed in the perioperative period in patients having undergone HSK/HZO. METHODS The PubMed and Web of Science databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning the prophylaxis against and risk of HSK/HZO recurrence in patients undergoing ocular surgery up to December 31, 2019. RESULTS The disturbance of the corneal nerve plexus occurs during several ocular surgeries including penetrating keratoplasty, lamellar keratoplasty, corneal cross-linking, cataract surgery, as well as photorefractive and phototherapeutic procedures. Such trauma, as well as modulation of the ocular immunological response caused by steroids applied postoperatively, might engender the HSK/HZO reactivation which is not uncommon. There is strong evidence that oral prophylaxis should be recommended just after surgery in patients undergoing penetrating keratoplasty and having suffered from HSK/HZO. For other types of surgeries, the evidence is less compelling; nevertheless, a period of disease quiescence and oral prophylaxis should still be considered. CONCLUSIONS Within the article, we discuss the available evidence for HSK/HZO prophylaxis in ocular surgery. Additional studies would be required to define the real risk of HSK/HZO recurrence following eye surgeries, and particularly cataract surgery, and to confirm the utility of perioperative HSK/HZO prophylaxis.
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Pham BH, Hien DL, Matsumiya W, Tuong Ngoc TT, Doan HL, Akhavanrezayat A, Yaşar Ç, Nguyen HV, Halim MS, Nguyen QD. Anti-interleukin-6 receptor therapy with tocilizumab for refractory pseudophakic cystoid macular edema. Am J Ophthalmol Case Rep 2020; 20:100881. [PMID: 32875161 PMCID: PMC7452126 DOI: 10.1016/j.ajoc.2020.100881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To describe the clinical course of a patient with refractory pseudophakic cystoid macular edema treated with interleukin-6 receptor antagonist tocilizumab. Observations An 80-year-old Caucasian man with past ocular history significant for glaucoma (right eye) and iritis presented with cystoid macular edema (CME) in the right eye (OD). His ocular surgery history was significant for cataract extraction with posterior chamber intraocular lenses in 1999 and YAG laser capsulotomy in 2014 in both eyes (OU). His medications at time of presentation included latanoprost and dorzolamide-timolol in OD for glaucoma, as well as prednisolone in OD for iritis. Upon examination, his visual acuity was 20/250 in OD and 20/20 in the left eye (OS). Intraocular pressure was 20 mmHg in OD and 10 mmHg in OS. Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed CME and a cup-to-disk ratio of 0.9 in OD and normal findings in OS. Initial spectral domain optical coherence tomography (SD-OCT) demonstrated intraretinal fluid in both outer and inner layers as well as mild subretinal fluid with an intact ellipsoid zone in OD. Fluorescein angiography revealed perifoveal leakage in OD. Laboratory evaluations, including infectious work-up, were unremarkable. While the patient's CME initially improved after initiation of therapy with topical prednisolone and oral acetazolamide, the CME later recurred after systemic acetazolamide was stopped due to intolerable side effects. Despite multiple therapeutic approaches, including topical and systemic corticosteroids (both oral and intravenous) and topical interferon α2b over the course of more than one year, the patient's visual acuity continued to worsen with increasing intra- and subretinal fluid in the macula. Due to the refractory CME, the patient was started on monthly infusions of anti-interleukin (IL)-6 receptor tocilizumab (8 mg/kg) with three days of methylprednisolone infusions (500 mg/day). After nine cycles of treatment, SD-OCT demonstrated restoration of normal foveal contour with complete resolution of CME. Conclusions and Importance IL-6 inhibition with tocilizumab may be a safe and effective treatment for refractory CME. Further studies are needed to elucidate the nature and extent of therapeutic IL-6 inhibition in CME.
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Affiliation(s)
| | - Doan Luong Hien
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | | | - Than Trong Tuong Ngoc
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | - Huy Luong Doan
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Çigdem Yaşar
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Huy Vu Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Corresponding author. Spencer Center for Vision Research Byers Eye Institute at Stanford University 2452 Watson Court Suite 200 Palo Alto, CA 94303, USA.
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Solomon KD, Sandoval HP, Potvin R. Comparing Combination Drop Therapy to a Standard Drop Regimen After Routine Cataract Surgery. Clin Ophthalmol 2020; 14:1959-1965. [PMID: 32764861 PMCID: PMC7360419 DOI: 10.2147/opth.s260926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a combined steroid/antibiotic/non-steroidal anti-inflammatory drop relative to a regimen of multiple drops after cataract surgery. SETTING Single clinical practice in the USA. DESIGN Prospective randomized contralateral eye study. METHODS Subjects presenting for bilateral cataract surgery were enrolled with contralateral eyes randomly assigned to one of the two groups. Test eyes received a combination therapy (prednisolone acetate 1%, gatifloxacin 0.5%, and bromfenac sodium 0.075%) while control eyes received the same medications in separate drops (bromfenac sodium was 0.07%). Subjects were examined 1, 15 and 30 days after surgery. Visual acuities were measured, along with the refraction, intraocular pressure, patient pain and satisfaction, macular thickness and corneal pachymetry. The primary measure of interest was the change in macular thickness from baseline to the 15- and 30-day visits. The frequency and severity of reported ocular adverse events were tabulated for each group and compared. RESULTS Thirty-three subjects completed the study. Changes in central macular thickness were similar between groups, with only one control eye exhibiting significant macular edema. No differences in visual acuity, corneal edema, cells or flare were observed between groups. There were eight mild adverse events reported for all eyes of all subjects; the difference in the number of eyes experiencing adverse events was not statistically significantly different between groups (p ≥ 0.05 for all comparisons). While subjective symptoms were similar, all subjects indicated that they preferred the combination drop. CONCLUSION A combination drop showed similar efficacy to multiple drops and was overwhelmingly preferred by subjects.
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Lee A, Blair HA. Dexamethasone Intracanalicular Insert: A Review in Treating Post-Surgical Ocular Pain and Inflammation. Drugs 2020; 80:1101-1108. [PMID: 32588339 PMCID: PMC7371664 DOI: 10.1007/s40265-020-01344-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dextenza®, an intracanalicular insert that is placed into the lower punctal opening of the eye, gradually releases dexamethasone for up to 30 days to alleviate pain and inflammation associated with ophthalmic surgery. A significantly higher proportion of patients treated with the dexamethasone intracanalicular insert than with the placebo insert had no pain at day 8 (co-primary endpoint, 7 days post-operation) across three pivotal phase III trials, and the inflammation co-primary endpoint (absence of anterior chamber cells) at day 14 (13 days post-operation) was met in two of three trials. Overall, the dexamethasone intracanalicular insert was effective and generally well tolerated for the treatment of post-surgical ocular pain and inflammation following cataract surgery. As low patient adherence is an issue for topical ophthalmic anti-inflammatory medications, the convenience (ease of insertion, single application with no patient input and typically no removal required) of the dexamethasone intracanalicular insert makes it a promising emerging option for the treatment of ocular inflammation and pain following ophthalmic surgery.
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Affiliation(s)
- Arnold Lee
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Hannah A Blair
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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Persistence of Inflammation After Uncomplicated Cataract Surgery: A 6-Month Laser Flare Photometry Analysis. Adv Ther 2020; 37:3223-3233. [PMID: 32440977 DOI: 10.1007/s12325-020-01383-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate, by laser photometry, the persistency of anterior chamber flare after uneventful phacoemulsification in asymptomatic patients with no signs of inflammation on slit lamp examination. METHOD Seventy-five patients previously enrolled in a randomized clinical trial that evaluated inflammation after uneventful phacoemulsification in eyes treated with dexamethasone 0.1% ophthalmic suspension (group 1) or bromfenac 0.09% ophthalmic solution (group 2) for 2 weeks. Anterior chamber inflammation was investigated by laser flare photometry. At 30 days after surgery, laser flare showed persistently elevated values. For this reason, patients were further analyzed at 3 and 6 months. Additionally, optical coherence tomography was used to measure the central macular thickness (CMT) and to assess for postoperative pseudophakic macular edema. RESULTS When compared to preoperative values, laser flare photometry demonstrated persistent ocular inflammation at postoperative days 90 and 180 in group 1, but not in group 2. Laser flare values showed a significant reduction in group 2 compared to group 1 throughout all the follow-up (p < 0.001). The increase in mean CMT at days 90 and 180 with respect to baseline was statistically significant in group 1 but not in group 2, in which it decreased to levels similar to preoperative value. Group 1 showed a higher increase in mean CMT compared to group 2 throughout all the follow-up (p < 0.001). The proportion of patients that developed pseudophakic cystoid macular edema (CME) was 14% (n = 5) and 0% (n = 0) in group 1 and group 2, respectively (p = 0.02). The bivariate analysis demonstrated a positive correlation between laser flare and CMT values in group 1 but not in group 2. CONCLUSION Anterior chamber inflammation persists for more than 30 days in a significant proportion of patients after uncomplicated cataract surgery and may be responsible for late onset of cystoid macular edema cases. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03317847.
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Mazet R, Yaméogo JBG, Wouessidjewe D, Choisnard L, Gèze A. Recent Advances in the Design of Topical Ophthalmic Delivery Systems in the Treatment of Ocular Surface Inflammation and Their Biopharmaceutical Evaluation. Pharmaceutics 2020; 12:pharmaceutics12060570. [PMID: 32575411 PMCID: PMC7356360 DOI: 10.3390/pharmaceutics12060570] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
Ocular inflammation is one of the most common symptom of eye disorders and diseases. The therapeutic management of this inflammation must be rapid and effective in order to avoid deleterious effects for the eye and the vision. Steroidal (SAID) and non-steroidal (NSAID) anti-inflammatory drugs and immunosuppressive agents have been shown to be effective in treating inflammation of the ocular surface of the eye by topical administration. However, it is well established that the anatomical and physiological ocular barriers are limiting factors for drug penetration. In addition, such drugs are generally characterized by a very low aqueous solubility, resulting in low bioavailability as only 1% to 5% of the applied drug permeates the cornea. The present review gives an updated insight on the conventional formulations used in the treatment of ocular inflammation, i.e., ointments, eye drops, solutions, suspensions, gels, and emulsions, based on the commercial products available on the US, European, and French markets. Additionally, sophisticated formulations and innovative ocular drug delivery systems will be discussed. Promising results are presented with micro- and nanoparticulated systems, or combined strategies with polymers and colloidal systems, which offer a synergy in bioavailability and sustained release. Finally, different tools allowing the physical characterization of all these delivery systems, as well as in vitro, ex vivo, and in vivo evaluations, will be considered with regards to the safety, the tolerance, and the efficiency of the drug products.
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Affiliation(s)
- Roseline Mazet
- DPM, UMR CNRS 5063, ICMG FR 2607, Faculty of Pharmacy, University of Grenoble Alpes, 38400 St Martin d’Hères, France; (R.M.); (D.W.); (L.C.)
- Grenoble University Hospital, 38043 Grenoble, France
| | | | - Denis Wouessidjewe
- DPM, UMR CNRS 5063, ICMG FR 2607, Faculty of Pharmacy, University of Grenoble Alpes, 38400 St Martin d’Hères, France; (R.M.); (D.W.); (L.C.)
| | - Luc Choisnard
- DPM, UMR CNRS 5063, ICMG FR 2607, Faculty of Pharmacy, University of Grenoble Alpes, 38400 St Martin d’Hères, France; (R.M.); (D.W.); (L.C.)
| | - Annabelle Gèze
- DPM, UMR CNRS 5063, ICMG FR 2607, Faculty of Pharmacy, University of Grenoble Alpes, 38400 St Martin d’Hères, France; (R.M.); (D.W.); (L.C.)
- Correspondence: ; Tel.: +33-476-63-53-01
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Topete A, Pinto CA, Barroso H, Saraiva JA, Barahona I, Saramago B, Serro AP. High Hydrostatic Pressure as Sterilization Method for Drug-Loaded Intraocular Lenses. ACS Biomater Sci Eng 2020; 6:4051-4061. [DOI: 10.1021/acsbiomaterials.0c00412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Topete
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049001 Lisboa, Portugal
| | - Carlos A. Pinto
- QOPNA & LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro 3810-193, Portugal
| | - Helena Barroso
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| | - Jorge A. Saraiva
- QOPNA & LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro 3810-193, Portugal
| | - Isabel Barahona
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| | - Benilde Saramago
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049001 Lisboa, Portugal
| | - Ana Paula Serro
- Centro de Química Estrutural, Departamento de Engenharia Química, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049001 Lisboa, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
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Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery. J Cataract Refract Surg 2020; 46:867-872. [DOI: 10.1097/j.jcrs.0000000000000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kandarakis SA, Petrou P, Papakonstantinou E, Spiropoulos D, Rapanou A, Georgalas I. Ocular nonsteroidal inflammatory drugs: where do we stand today? Cutan Ocul Toxicol 2020; 39:200-212. [PMID: 32338073 DOI: 10.1080/15569527.2020.1760876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Since their first introduction in ophthalmology, the use of NSAIDs (nonsteroidal anti-inflammatory drugs) has been exponentially expanded, with numerous therapeutic applications. Despite their controversial history, they have proven their efficacy as anti-inflammatory agents in a variety of diseases. Nowadays, NSAIDs are part of surgical protocols of the most commonly performed ophthalmic operations, such as cataract or ocular surgery. They are universally implicated in the management of conjunctivitis, retinal and choroidal disease and miscellaneous inflammatory diseases. Moreover, although linked with serious adverse events and toxicities, their therapeutic magnitude in Ophthalmology should not be affected. This review systematically portrays the variety of ocular NSAIDs available to date, along with their differences in their way of action, indications and potential side effects in various ophthalmologic conditions.
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Affiliation(s)
- S A Kandarakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - P Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - E Papakonstantinou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - D Spiropoulos
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - A Rapanou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - I Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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Lorenzo-Veiga B, Diaz-Rodriguez P, Alvarez-Lorenzo C, Loftsson T, Sigurdsson HH. In Vitro and Ex Vivo Evaluation of Nepafenac-Based Cyclodextrin Microparticles for Treatment of Eye Inflammation. NANOMATERIALS 2020; 10:nano10040709. [PMID: 32283583 PMCID: PMC7221994 DOI: 10.3390/nano10040709] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study was to design and evaluate novel cyclodextrin (CD)-based aggregate formulations to efficiently deliver nepafenac topically to the eye structure, to treat inflammation and increase nepafenac levels in the posterior segment, thus attenuating the response of inflammatory mediators. The physicochemical properties of nine aggregate formulations containing nepafenac/γ-CD/hydroxypropyl-β (HPβ)-CD complexes as well as their rheological properties, mucoadhesion, ocular irritancy, corneal and scleral permeability, and anti-inflammatory activity were investigated in detail. The results were compared with a commercially available nepafenac suspension, Nevanac® 3 mg/mL. All formulations showed microparticles, neutral pH, and negative zeta potential (–6 to –27 mV). They were non-irritating and nontoxic and showed high permeation through bovine sclera. Formulations containing carboxymethyl cellulose (CMC) showed greater anti-inflammatory activity, even higher than the commercial formulation, Nevanac® 0.3%. The optimized formulations represent an opportunity for topical instillation of drugs to the posterior segment of the eye.
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Affiliation(s)
- Blanca Lorenzo-Veiga
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
| | - Patricia Diaz-Rodriguez
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Ciencias de la Salud, Universidad de la Laguna (ULL), Campus de Anchieta, 38200 La Laguna (Tenerife), Spain;
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Thorsteinn Loftsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
| | - Hakon Hrafn Sigurdsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Hofsvallagata 53, IS-107 Reykjavik, Iceland; (B.L.-V.); (T.L.)
- Correspondence:
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Rate of pseudophakic cystoid macular edema using intraoperative and topical nonsteroidal antiinflammatory drugs alone without steroids. J Cataract Refract Surg 2020; 46:350-354. [PMID: 32142038 DOI: 10.1097/j.jcrs.0000000000000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the rate of postoperative cystoid macular edema (CME) in patients undergoing cataract surgery treated with intraoperative intracameral and postoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) without steroids. SETTING Academic outpatient surgery center Wake Forest Baptist Health in Bermuda Run, NC. DESIGN Retrospective cohort study. METHODS A retrospective chart review was performed. Patients were identified through a medical record search tool using criteria of the Current Procedural Terminology code (66984), a single surgeon, and a date range from January 1, 2016, through December 31, 2017. Medical records were reviewed to determine intraoperative and postoperative medication regimen, visual outcome, and development of postoperative CME. Patients with a history of uveitis, diabetic macular edema, retinal vein occlusions, epiretinal membranes, vitreomacular traction, or any prior macular edema were excluded. In addition, any patients with less than 6 weeks of postoperative follow-up were excluded. RESULTS Overall, 824 patient records were reviewed, and the analysis included 504 eyes. Of these, 2 eyes developed postoperative CME (rate = 0.40%, 95% CI 0.0005 to 0.0143). CONCLUSIONS The rate of CME in patients treated with intraoperative and postoperative NSAIDs without steroids was low and below the historical rates derived from a literature review of CME development with the use of steroids.
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Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
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Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
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Chua AWY, Chua MJ, Harrisberg BP, Kumar CM. Review of anaesthetic management for cataract surgery in transplant recipients. Anaesth Intensive Care 2020; 48:25-35. [DOI: 10.1177/0310057x19891737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prevalence of transplantation is on the increase worldwide. Corneal transplantation is the most common form of human donor transplantation. Transplantation of other organs and bone marrow is established treatment for various end-organ failure and many haematological conditions, respectively. Success and survival of these patients have increased with advances in immunosuppression. Unfortunately, these patients are susceptible to cataract formation as a consequence of immunosuppressive therapy and accelerated progression of several diseases. Topical anaesthesia and regional ophthalmic blocks are ideal for cataract surgery in cooperative adults. General anaesthesia may be required in children, for extremely anxious or claustrophobic adults and for complex surgery such as simultaneous cataract and corneal transplantation. The perioperative anaesthetic management of cataract surgery in a transplant recipient is no different to a standard technique in a healthy adult, but additional challenges are posed by the underlying pathology necessitating transplantation, function of the transplanted organ, physiological and pharmacological problems of allograft denervation, side-effects of immunosuppression, risk of infection and potential for rejection. This narrative review summarises optimal anaesthetic management in transplant recipients undergoing cataract surgery.
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Affiliation(s)
- Alfred WY Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | | | - Brian P Harrisberg
- Ophthalmology Department, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
- Newcastle University, Newcastle, UK
- Newcastle University Medical School, Johor, Malaysia
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Abstract
PURPOSE OF REVIEW Routine prophylaxis for adverse events following cataract surgery is evolving. Prior reliance on topical eyedrop instillation by patients is giving way to surgeon directed injections at the time of cataract surgery. The benefit of this new approach is assured delivery of drugs in standardized doses which should optimize the healing process and reduce the incidence of untoward events with higher confidence. RECENT FINDINGS Adoption rates of intracameral antibiotic injection amongst European and American cataract surgeons is increasing. Techniques to inject periocular corticosteroid for routine inflammation prophylaxis are also in development. In combination with intraoperative pharmacologic dilation, a drop-free modality can be achieved. SUMMARY Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation, and topical drop-associated corneal issues.
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Affiliation(s)
- Neal H Shorstein
- Departments of Ophthalmology and Quality, Shorstein - Kaiser Permanente, Oakland, California; Department of Ophthalmology, Myers - Northwestern University, Chicago, IL
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Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol 2020; 65:1-11. [DOI: 10.1016/j.survophthal.2019.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
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Grzybowski A, Brockmann T, Kanclerz P, Pleyer U. Dexamethasone Intraocular Suspension: A Long-Acting Therapeutic for Treating Inflammation Associated with Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:525-534. [DOI: 10.1089/jop.2019.0072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrzej Grzybowski
- University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Tobias Brockmann
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Uwe Pleyer
- Department of Ophthalmology, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Jinagal J, Sahu S, Gupta G, Khurana S, Gupta R, Gupta PC, Ram J. Quantification of Inflammation Following Nd:YAG Laser Capsulotomy and Assessing the Anti-inflammatory Effects of Nepafenac 0.1% and Betamethasone 0.1. Ocul Immunol Inflamm 2019; 29:411-416. [PMID: 31638843 DOI: 10.1080/09273948.2019.1668025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To quantify the intraocular inflammation, measured using laser flare photometry (LFP), after Nd:YAG capsulotomy and compare the effects of different topical anti-inflammatory regimes.Methods: A single-center, prospective, randomized controlled study, which included 90 eyes of 90 patients with visually significant posterior capsular opacification. In all patients, Nd:YAG capsulotomy was done and was then randomized into three groups: (A) Topical betamethasone 0.1%; (B) Topical nepafenac 0.1%; and (C) Control group: did not receive any anti-inflammatory agent post capsulotomy.Results: There was a significant increase in the mean LFP values 2 h following laser capsulotomy (p < 0.001) and then declined gradually and came back to pre-laser values by 2 weeks in all three groups. The mean LFP values, central macular thickness, and best corrected visual acuity were comparable among groups. None developed central macular edema.Conclusion: Intraocular inflammation following Nd:YAG capsulotomies is minimal and transient. Routine use of prophylactic anti-inflammatory agents may be avoided.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabin Sahu
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Anterior Chamber Inflammation After Cataract Surgery: A Randomized Clinical Trial Comparing Bromfenac 0.09% to Dexamethasone 0.1. Adv Ther 2019; 36:2712-2722. [PMID: 31482510 DOI: 10.1007/s12325-019-01076-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the efficacy of bromfenac 0.09% and dexamethasone 0.1% in the treatment of anterior chamber inflammation after uncomplicated cataract surgery. METHODS Seventy-six patients with senile cataracts and no other ocular comorbidities who underwent uneventful phacoemulsification were randomized 1:1 to receive dexamethasone ophthalmic suspension 0.1% or bromfenac ophthalmic solution 0.09% for 2 weeks. All patients were examined on the day before surgery and postoperatively at day 1, 3, 7, 9, 11, 14 and 30. Laser flare photometry was used to quantify anterior chamber inflammation and optical coherence tomography to measure macular thickness. RESULTS Bromfenac was as effective as dexamethasone in reducing inflammation in the anterior chamber of the eye. Laser flare increased the day after surgery and progressively decreased after starting the treatment with no statistically significant difference between dexamethasone and bromfenac at all time points. Visual acuity improved steadily after surgery in both groups. Mean macular thickness was similar in both the dexamethasone and bromfenac arms at 1 month. CONCLUSIONS Short-term therapy with topical bromfenac alone is as effective as dexamethasone in low-risk cataract surgery patients. TRIAL REGISTRATION ClinicalTrials.gov # NCT03317847; EudraCT # 2016-004358-14. FUNDING Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy.
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Bromfenac Ophthalmic Solution 0.07% Versus Nepafenac Ophthalmic Suspension 0.3% for Post-Cataract Surgery Inflammation: A Pilot Study of Identical Dosing Regimens with Pre-Surgical "Pulse" Dose. Ophthalmol Ther 2019; 8:577-587. [PMID: 31552543 PMCID: PMC6858409 DOI: 10.1007/s40123-019-00215-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction This small pilot study is the first direct comparison of the currently marketed formulations of bromfenac (0.07% solution) and nepafenac (0.3% suspension) using identical dosing regimens and including an extra pre-surgical “pulse” dose in patients undergoing cataract surgery. Methods Adults scheduled for unilateral phacoemulsification with intraocular lens implantation were randomly assigned to bromfenac 0.07% or nepafenac 0.3%, each given once-daily 1 day prior to surgery, on the day of surgery plus an extra dose 1 h before surgery, and for 14 days after surgery. Assessments included summed ocular inflammation score (SOIS), visual acuity (VA), and retinal thickness measured via optical coherence tomography. Results The study population included 49 patients (bromfenac, n = 24; nepafenac, n = 25). The percentage of patients with a SOIS = 0 (no cells or flare) at post-surgical day 15 (primary efficacy endpoint) was statistically similar between the bromfenac (57.1%) and nepafenac (50.0%) treatment groups (intent-to-treat with last observation carried forward) (P = 0.6318). The proportions of patients with an SOIS of 0 at days 3 and 8 were significantly (P < 0.05) higher in the bromfenac group (23.8 and 52.4%, respectively) versus the nepafenac group (0.0 and 20.8%, respectively). Visual acuity was similar between groups at each study visit, as were mean retinal thickness and change from baseline in retinal thickness. Rescue medication (typically difluprednate) was given on or before day 15 to 13 patients in each treatment group (bromfenac, 54.2%; nepafenac, 52.0%). There were no adverse events considered to be related to either treatment. Conclusions The results of this small pilot study suggest that once-daily bromfenac 0.07% produces similar benefits with regard to postsurgical inflammation, VA, and retinal thickness as once-daily nepafenac 0.3%, and possibly has a faster onset of anti-inflammatory action, when compared using identical dosing regimens. Funding Bausch & Lomb Incorporated. Trial Registration NCT03886779.
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Nanomedicine for the effective and safe delivery of non-steroidal anti-inflammatory drugs: A review of preclinical research. Eur J Pharm Biopharm 2019; 142:179-194. [DOI: 10.1016/j.ejpb.2019.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/22/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
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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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Bizrah M, Yusuf A, Ahmad S. An update on chemical eye burns. Eye (Lond) 2019; 33:1362-1377. [PMID: 31086244 PMCID: PMC7002428 DOI: 10.1038/s41433-019-0456-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023] Open
Abstract
Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.
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Affiliation(s)
- Mukhtar Bizrah
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
| | - Ammar Yusuf
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
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Shetty R, Dalal R, Nair AP, Khamar P, D’Souza S, Vaishnav R. Pain management after photorefractive keratectomy. J Cataract Refract Surg 2019; 45:972-976. [DOI: 10.1016/j.jcrs.2019.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/31/2018] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
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Topete A, Serro A, Saramago B. Dual drug delivery from intraocular lens material for prophylaxis of endophthalmitis in cataract surgery. Int J Pharm 2019; 558:43-52. [DOI: 10.1016/j.ijpharm.2018.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
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Hovanesian J, Holland E. Tolerability and toxicity of topically applied nepafenac 0.3% compared with generic ketorolac 0.5%. J Cataract Refract Surg 2019; 45:174-180. [DOI: 10.1016/j.jcrs.2018.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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Abstract
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.
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Anisimova NS, Arbisser LB, Petrovski G, Petrichuk SV, Sobolev NP, Petrovski B, Borsenok SA, Komah YA, Malyugin BE. Effect of NSAIDs on Pupil Diameter and Expression of Aqueous Humor Cytokines in FLACS Versus Conventional Phacoemulsification. J Refract Surg 2018; 34:646-652. [DOI: 10.3928/1081597x-20180814-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
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