Moderator
Nick Mamalis, MD
Panelists
Tat-Keong Chan, MD, FRCS
Sarah H. Van Tassel, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Eric D. Donnenfeld, MD, FACS
Co-Authors
Sahas Narain MD, David Rabinovitch MD, Talia Shoshany MD
Purpose
In follow-up to prior animal studies, we compared the concentration of ketorolac in aqueous humor samples during cataract surgery and in vitreous humor samples during pars plana vitrectomy in patients receiving preoperative topical ketorolac 0.4% or intracameral phenylephrine 1.0%/ketorolac 0.3% (OMIDRIA, Rayner Surgical, Bellevue, WA).
Methods
Patients undergoing combined cataract surgery immediately followed by pars plana vitrectomy are randomized in a 1:1 fashion to receive intraoperative phenylephrine 1.0%/ketorolac 0.3% or topical ketorolac 0.4% for 3 days prior to surgery. Aqueous and vitreous samples are taken during the combined procedure, frozen, and sent to an independent lab (Emery Pharma, Alameda, CA) to analyze ketorolac concentrations. Ketorolac levels are determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The lab personnel performing sample analysis and the biostatistician analyzing the data are masked to treatment arm.
Results
5 study patients received ketorolac intracamerally and 6 control patients, topically. The mean aqueous ketorolac level was 20868.2 � 7342.4 ng/mL in the intracameral arm and 635.1 � 909.6 ng/mL in the topical arm (P<0.0001). in="" the="" vitreous,="" the="" mean="" ketorolac="" concentration="" in="" the="" intracameral="" arm="" was="" 2508.8="" �="" 4477.6="" ng/ml="" vs.="" 3.1="" �="" 7.7="" ng/ml="" in="" the="" topical="" arm="" (p="0.0004)." the="" intracameral="" patients="" achieved="" a="" 188="" x="" greater="" concentration="" of="" ketorolac="" in="" aqueous="" and="" a="" 198="" x="" greater="" concentration="" in="" vitreous="" vs.="" topical="" patients.="" the="" patients="" receiving="" intracameral="" phenylephrine/ketorolac="" achieved="" statistically="" higher="" concentrations="" of="" ketorolac="" in="" both="" aqueous="" and="" vitreous="" vs.="" topical="">
Conclusion
This is the first study to evaluate aqueous and vitreous levels of ketorolac with topical and intracameral therapy. The elevated vitreous levels of ketorolac may explain improved visual results and less CME with intracameral therapy and may reduce the need for topical anti-inflammatory therapy during cataract surgery.
Presenting Author
Y Ralph Chu, MD
Co-Authors
Mitch Jackson MD, Konstantinos Charizanis MBA, PhD, Mitchell Brigell PhD, Jay Pepose PhD, MD
Purpose
Pharmacologically induced mydriasis can lead to photophobia, discomfort, and vision impairment. The MIRA-2 and MIRA-3 studies assessed the efficacy of 0.75% phentolamine ophthalmic solution (POS) to reverse pharmacologically induced mydriasis (RM). The effect of POS intervention on patient reported outcomes (PRO) is reported here.
Methods
MIRA-2 and MIRA-3 were Phase 3 multi-center, randomized, placebo-controlled, double-masked clinical trials (n=553; age ?12 years). Subjects were randomized to mydriatic agent 3:1:1 (2.5% phenylephrine, 1% tropicamide, or Paremyd) and treatment 2:1 (POS or placebo, respectively). Subjects completed a survey consisting of 5 questions regarding difficulty reading text, difficulty with blurry text, distance vision blurrier than normal, words were going in and out of focus and overall satisfaction with their vision pre- and post-dilation and multiple time points post treatment. A post-hoc analysis of the number of subjects returning to the Baseline (-1 hour) response was performed.
Results
More POS-treated subjects returned to baseline difficulty reading text compared to placebo at 60 minutes (69.8% vs 44.8%, p=0.002) and 3 to 4 hours (95.8% vs 84.5%, p=0.02). More POS-treated subjects compared to placebo returned to baseline level of blurry vision at 1.5 to 2 hours (82.4% vs 66.3%, p=0.003) and 3 to 4 hours (93.3% vs 84.2%, p=0.02). More subjects receiving POS with complaints of distance vision becoming blurrier than normal returned to baseline at 60 min (44.3% vs 29%, p=0.01) and 1.5 to 2 hours (60% vs 38.3%, p=0.0001). More subjects receiving POS than placebo were satisfied with their vision at 60 min (51.5% vs 30.5%, p=0.01) and 1.5 to 2 hours (72.3% vs 53.7%, p=0.01).
Conclusion
Subjects receiving POS report a perceived benefit in the resolution of visual symptoms caused by pharmacologically induced mydriasis. The onset of these subjective reported outcomes precede the full return to ?0.2mm of pupil diameter and reflect an enhanced functional time savings.
Presenting Author
Jeffrey H. Levenson, MD, ABO
Co-Authors
Michael Korenfeld MD, Steven Silverstein MD, FACS, Ehsan Sadri MD, Jason Bacharach MD, Derek Nunez MD, Laurene Wang MS, PhD, Julie Whitcomb PhD, Eva Liang MD, Erick Co PhD
Purpose
To evaluate the efficacy and safety of clobetasol propionate ophthalmic suspension 0.05% (CPN) for the treatment of inflammation and pain after cataract surgery in two pivotal Phase 3 studies (with integrated analyses of both studies) for regulatory approval.
Methods
Two multicenter, randomized, double-masked, placebo-controlled, parallel-group studies were conducted. Patients undergoing routine unilateral uncomplicated cataract surgery were randomized 1:1 to receive CPN (N=366) or placebo (N=382) BID for 14 days post-op. Primary efficacy endpoints were the proportion of subjects with anterior chamber cell (ACC) count=0 at days 8-15 and proportion with ocular pain grade=0 at days 4-15. Secondary endpoints included ACC grade, anterior chamber flare grade, and ocular pain grade at each post-op visit. Safety was assessed by adverse events (AEs), changes in IOP, BCVA, endothelial cell count (ECC), slit-lamp biomicroscopy, and dilated ophthalmoscopy.
Results
Significantly more CPN-treated subjects achieved ACC=0 at days 8-15 than those treated with placebo (26.5% vs. 6.8%, p<0.001). the="" proportion="" of="" patients="" with="" ocular="" pain="" grade="0" at="" days="" 4-15="" was="" also="" significantly="" higher="" with="" cpn="" than="" placebo="" (71.6%="" vs.="" 27.7%,=""><0.001). cpn-treated="" subjects="" showed="" a="" more="" rapid="" rate="" of="" improvement="" and="" greater="" magnitude="" of="" improvement="" in="" the="" bcva="" by="" day="" 4.="" significantly="" fewer="" cpn="" subjects="" required="" rescue="" medication="" (6.3%="" vs.="" 44.8%,=""><0.001). iop="" increases="" were="" similar="" between="" groups,="" with="" 1.4%="" of="" subjects="" in="" the="" cpn="" group="" experiencing="" iop="" increase="" per="" protocol.="" cpn="" was="" well-tolerated="" overall,="" with="" minimal="" aes="" and="" similar="" corneal="" ecc="" changes="" to="">
Conclusion
Clobetasol propionate ophthalmic suspension 0.05% BID for 14 days provides rapid and sustained reduction of ocular inflammation and pain post ocular surgery. It is well tolerated with minimal IOP elevation, faster and greater VA improvement, and an AE profile similar to placebo, offering an efficient, effective option following cataract surgery.
Presenting Author
Angelica Hanna, BSc
Co-Authors
Ike Ahmed FRCSC, MD, James Armstrong MD, PhD, Cindy Hutnik MD, PhD, Efstathia Tsioros MSc
Purpose
Cataract surgery is widely performed globally, with recent major advancements improving techniques and outcomes. Sedation practices vary, with centers providing intravenous (IV), oral or no sedation for surgery. The purpose of this review is to assess the effectiveness of IV sedation compared to non-IV sedation for routine cataract surgery.
Methods
Medline, Embase, Cochrane Library, BIOSIS, Web of Science, and CINAHL were searched from inception to July 2024 for relevant articles containing original data. Randomized controlled trials that compared IV to non-IV sedation and 1) used a validated pain scale to report on pain or 2) reported on perioperative complications were included. Risk of bias was assessed using the Cochrane�s Risk of Bias Tool. A random effects meta-analysis was conducted and odds ratios, standard mean differences, 95% confidence intervals (CIs), and I� statistics were reported. The review was registered in PROSPERO (registration number CRD42024582495) and PRISMA guidelines were followed.
Results
12 randomized controlled trials including 1269 patients were included in the meta-analysis. IV sedation was associated with significantly decreased pain scores compared to no sedation (SMD = -0.98, 95% CI -1.68 to -0.29, p=0.006). Comparison of IV sedation to oral sedation showed no statistically significant difference in pain scores between groups (SMD = -0.56, 95% CI -1.60 to 0.48, p=0.29). Analysis of perioperative complications showed that patients with IV sedation were more likely to have adverse events when compared to patients receiving non-IV anesthesia (OR = 1.07, 95% CI 0.34 to 3.41).
Conclusion
For routine cataract surgery, IV sedation was associated with significantly lower pain scores compared to no sedation, but oral and IV sedation provided comparable pain control. Perioperative complications seem to occur at slightly higher rates in patients who receive IV sedation. These findings may inform sedation practices for cataract surgery.
Presenting Author
Winnie W Yu, MSc
Co-Authors
Abdus Sami Asim BSc, Fahmeeda Murtaza MD, Hannah Chiu MD, FRCSC, Eric Tam MD, FRCSC, Sohel Somani MD, FRCSC
Purpose
To assess the effectiveness of multi-treatment pre-cataract surgery ocular hygiene regimens (OHRs) with or without oral omega-3 supplements on improving tear osmolarity and reducing microbial load and inflammation in patients with dry eyes undergoing cataract surgery as compared to single treatment OHR.
Methods
This prospective, open label, randomized clinical trial included 159 cataract surgery patients aged >18 years with mild to severe dry eyes, defined by a Canadian Dry Eye Assessment questionnaire score of ? 5. Patients were randomized to one of three OHR groups, 1) single-treatment, 2) multi-treatment or 3) multi-treatment with oral omega-3 starting 30 days prior to cataract surgery until 1-month post-operative. Primary outcomes included tear osmolarity (mOsm/L), conjunctival microbial load (CFU/mL) and elevation of inflammatory marker matrix metalloproteinase 9.
Results
There were a total of 31 patients (61% female, mean age 71 years) included in the preliminary data of this study. Of these patients, 8 were randomized into OHR group 1, 16 in group 2 and 7 in group 3. No significant differences in tear osmolarity were seen between groups at pre-operative assessment (2-5 days prior to cataract surgery) visit and post-operative month 1 (POM1) visit (p>0.05). Similarly, there were no between group differences in conjunctival microbial load at pre-operative assessment visit and POM1 (p>0.05). Preliminary data on the proportion of inflammatory marker in each group is not sufficient to statistically analyze and will be reported at the completion of the full study.
Conclusion
In our preliminary data of patients with dry eyes undergoing cataract surgery, no significant differences were observed in tear osmolarity or conjunctival microbial load between single or multi-treatment OHRs with or without omega-3. Future steps would include increasing sample size to better characterize the possible effects of OHR treatments.
Presenting Author
Jared Raabe, MD
Co-Authors
Osamah Mian BEng, Hassaan Asif BSc, Umar Sandhu BA, Karanpreet Multani BSc, Asim Farooq MD, Kai Ding PhD, Kamran Riaz MD, Liam Redden BSc, MD
Purpose
Compare outcomes between intravitreal antibiotic steroid (IVAS) injection (moxifloxacin-triamcinolone) and postoperative topical nonsteroidal antiinflammatory drugs (NSAID), Intracameral Dexamethasone-Moxifloxacin-Ketorolac (IDMK), and a standard 3-drop therapy (TDT) regimen (topical antibiotic, steroid, and NSAID) in eyes after cataract surgery.
Methods
A retrospective comparative clinical cohort study in 3 centers in the U.S. A total of 2643 eyes (N = 2643 patients) underwent cataract surgery with IVAS-NSAID, IDMK, or TDT between 2017 and 2024. Preoperative data were included, including patients' age, iris color, medical history, and ocular history. Postoperative data, including best-corrected visual acuity, intraocular pressure (IOP), and the need for IOP-lowering medications, were recorded at 1-week, 1-month, and 6-months. Primary outcome measures compared between the 3 groups were postoperative complications, defined as persistent anterior chamber inflammation, persistent corneal edema, rebound inflammation, and cystoid macular edema.
Results
After exclusions, a total of 2468 eyes were analysed, with 325 IDMK, 1,079 IVAS-NSAID, and 1064 TDT eyes. Race (p<0.0001) and="" age="" (p="0.0023)" varied="" significantly="" across="" groups.�preop="" bcva�was="" worse="" in="" tdt="" (p="0.0001).�POD1" ucva�was="" significantly="" different=""><0.0001), with="" tdt="" showing="" the="" worst="" outcomes,="" though�pow1="" ucva�was="" similar="" across="" groups="" (p="0.3449).�POD1" iop�was="" highest="" in="" tdt=""><0.0001), with="" greater="" need="" for="" pressure-lowering="" drops="" (p="0.0072)." by�pom1,="" iop="" stabilized="" across="" groups.�persistent="" anterior="" chamber="" inflammation="" (paci,="" p="0.0293)" and="" rebound="" iritis="" (ri,="" p="0.0366)�were" more="" frequent="" in="" ivas-nsaid="" and="" tdt.�cme="" (1.5%)="" and="" corneal="" edema="" (6.5%)�occurred="" at="" similar="">
Conclusion
While early postop VA and IOP outcomes varied, differences diminished over time. TDT had worse initial VA, higher IOP, and greater need for IOP-lowering drops. IVAS-NSAID and TDT had higher PACI and RI rates. Perioperative medication choice impacts early recovery, with IVAS-NSAID and IDMK as safe alternatives to topical regimens.
Presenting Author
Cathleen M. McCabe, MD
Co-Authors
Inder Singh MD, Brian Shafer MD
Purpose
To determine if the administration of intracameral phenylephrine 1.0%/ketorolac 0.3%, subconjunctival triamcinolone acetonide, and intracameral moxifloxacin results in an equal or lower proportion of patients developing complications than those receiving traditional perioperative topical eye drops.
Methods
This randomized, prospective, multi-center study is enrolling 94 bilateral cataract surgery patients (188 eyes). One eye is randomized as the control (pre- and post-surgical self-administration of topical NSAID & antibiotic and post-surgical topical steroid) and the other as the study eye (intracameral phenylephrine 1.0%/ketorolac 0.3% and antibiotic, and subconjunctival steroid). The primary endpoint is the proportion of patients with inflammation on Day 8. Secondary endpoints include complication rates, rate of CME, need for rescue therapy, and patient-reported pain, discomfort, and overall satisfaction.
Results
Patients had a mean age of 68 years (59.6% female). On Day 8, mean inflammation (0-4 scale) in study eyes was 0.131�0.31 vs. 0.139�0.30 in control eyes (P=0.857). Difference in inflammation was not statistically different on Day 1 (0.828 study vs. 0.707 control, P=0.083) or Day 30 (0.000 study vs. 0.016 control, P=0.182) either. There was no statistical difference in patient-graded pain (0-4 scale) at Day 1 (0.152 study vs. 0.228 control, P=0.282) or Day 8 (0.126 study vs. 0.077 control, P=0.329). On Day 30, patients graded their overall satisfaction with the postoperative regimen on a scale of 1-10. Study patients graded satisfaction at 8.85�1.61 vs. control patients at 6.48�2.66 (P< />
Conclusion
Inflammation and pain in the dropless arm were non-inferior to standard topical drops, while patients statistically preferred the dropless regimen. These data may provide surgeons with the confidence to explore a similar dropless regimen including phenylephrine/ketorolac.
Presenting Author
Junkyu Chung, MD
Co-Authors
Yeokyoung Won PhD, Won Seok Song MD, Dong Hui Lim MD, PhD, Han Ul Kim MD
Purpose
This study aims to compare the effectiveness of dry eye management using Rebamipide (RB) alone versus a combination of Diquafosol (DF) and Cyclosporin (CS) in patients undergoing cataract surgery.
Methods
This study included patients who underwent cataract surgery in 2024 without prior treatment for dry eye. Participants were randomly assigned to either the RB group or the DF and CS combination group. Treatments were administered from 1 month before surgery and continued for 3 months post-surgery. MMP-9, Tear Film Break-Up Time (BUT), Oxford grade, Schirmer test, and OSDI were assessed at baseline, 1 month, and 3 months post-surgery. BUT and Oxford grade were also measured on the day of surgery and 1 week post-surgery.
Results
Thirty patients were included. 15 patients (22 eyes) in the RB group and 15 patients (20 eyes) in the DF and CS group. At baseline, no significant differences were found except BUT. BUT was shorter in the RB group than in the DF and CS group (p < 0.01). In the RB group, BUT increased from baseline to the day of surgery (0.18 � 0.49) and from the day of surgery to 1 week post-surgery (0.74 � 0.53). In the DF and CS group, BUT showed an increase from baseline to the day of surgery (0.38 � 0.86) but worsened from the day of surgery to 1 week post-surgery (-2.78 � 1.65). At 1 month and 3 months post-surgery, both groups showed improvements in MMP-9 and OSDI.
Conclusion
Both RB alone and the combination of DF and CS effectively managed dry eye in cataract surgery. RB alone is particularly effective for patients with short BUT evaporative dry eye, demonstrating its utility as a single treatment option before and after cataract surgery.
Presenting Author
Kartik Gannamaneni, BSc
Co-Authors
Jeremy Shapiro BA, Harry Levine MPH, MD, Angela Verkade MD, Stephen Armenti PhD, MD, Shahzad Mian MD
Purpose
To determine the efficacy of a dexamethasone intracanalicular insert (DII) to prevent breakthrough inflammation (iritis or cystoid macular edema) after cataract surgery when compared to a single perioperative subconjunctival triamcinolone acetonide 40 mg/ml injection (STAI).
Methods
Retrospective cohort study of standard phacoemulsification with posterior chamber intraocular lens placement between June 2000 and March 2023. 266 eyes of 174 patients received a DII intraoperatively without additional anti-inflammatory treatment. 53 eyes of 31 patients received a single STAI intraoperatively without additional anti-inflammatory treatment. Patients were excluded with history of iritis, ocular infection, glaucoma, intraoperative posterior capsular rupture, vitreous prolapse, or retained lens fragments. Post-op visits were reviewed for breakthrough inflammation requiring additional anti-inflammatory drops, cystoid macular edema, and intraocular pressure at one-month post-op.
Results
The DII and STAI groups were well-matched in terms of age, race, ethnicity, and comorbidity status. Rebound inflammation occurred in 24 (9.0%) DII eyes and 2 (3.8%) STAI eyes (p=.01), while CME was observed in 13 (4.9%) DII eyes and 1 (1.9%) STAI eye (p=.75). Both groups showed no cases of increased IOP >10 mmHg at 1-month post-op compared to preoperative IOP.
Conclusion
Post-cataract surgery, DII shows slightly higher rebound inflammation rates than STAI, with no significant differences in CME rates or postoperative IOP increases. Both DII and STAI are safe and effective dropless anti-inflammatory prophylaxis, but STAI may offer better anti-inflammatory effect. Further studies comparing the two are required.
Presenting Author
Jeremy N Shapiro, BA
Co-Authors
Kartik Gannamaneni BSc, Shahzad Mian MD
Purpose
To compare patient satisfaction and perioperative efficiency of oral vs. standard IV sedation in routine cataract surgery
Methods
Retrospective study of consecutive simple cataract surgeries between January 2024 and August 2024. Patients received either preoperative 5 mg oral midazolam or pre/intraoperative IV midazolam and/or fentanyl of variable dosage titrated by anesthesia. Event times were collected from the EMR and satisfaction surveys were administered to patients at post-op day 1. Satisfaction surveys were scaled from 1 (strongly disagree) to 5 (strongly agree) when applicable. P values were calculated using unpaired, two-tailed t-test.
Results
Cataract surgery in 210 eyes of 156 patients were included. 52 procedures with oral sedation and 158 procedures with standard IV sedation were completed. Between oral and IV sedation, average procedure times (13.1 vs. 13.1 mins, p = .95) and average PACU stay times (32.6 vs. 33.1 mins, p = .79) were similar. Reported patient discomfort (1.7 vs. 1.7, p = .81), pain (1.6 vs. 1.3, p = .05), nausea (1.1 vs. 1.1, p = .82), and post-op disorientation (1.7 vs. 1.5, p = .29) were similar between oral and IV groups. Anxiety among oral sedation patients was slightly higher (2.5 vs. 1.8, p < 0.01). 54% of surveyed patients noted that IV placement was more uncomfortable than cataract surgery itself.
Conclusion
Oral and IV sedation showed minimal differences in patient satisfaction and perioperative efficiency. Intraoperative anxiety and pain may be slightly higher among oral sedation patients. These data may support oral sedation as an alternative to IV sedation for simple cataract surgery and other minor anterior segment surgeries.
Presenting Author
Monique Barbour, MD, ABO
Purpose
Offering cataract surgery patients a regimen that allows less reliance on complicated postoperative eye drop schedules is one way to enhance their experience. The purpose of this study is to review outcomes in patients who have undergone dropless cataract surgery and compare these to patients receiving more traditional postoperative drop regimens.
Methods
This retrospective chart review will assess postoperative outcomes from cataract surgery patients who received either intracameral phenylephrine 1.0%/ketorolac 0.3%, moxifloxacin 0.5 mg/0.1 mL, and dexamethasone 0.4 mg/0.1mL, plus a dexamethasone ophthalmic insert (0.4 mg for up to 30 days) at the 1-day postoperative visit, or topical prednisolone acetate 1%, diclofenac 0.1%, and ciprofloxacin 0.3% QID for 1 week, followed by prednisolone acetate and diclofenac BID for 3 weeks. Assessments will include an evaluation of both intraoperative and postoperative pain and comfort, BCVA, need for rescue therapy, anterior segment inflammation, and CME out to 8 weeks.
Results
In a retrospective study of 25 patients who underwent uncomplicated cataract surgery and followed the dropless post-op regimen, 96% (24/25) experienced no discomfort, inflammation or infection on days 1, 7 and 28, during the 4 weeks long post operative period. Minimal adverse events (4% photophobia, 8% redness) were documented. One patient experienced an IOP spike of 20% from baseline, 1 patient experienced corneal edema and only 1 patient demonstrated anterior chamber cell and flare after 7 days.
Conclusion
.The dropless approach Involves injecting compounded medications directly into the eye's anterior chamber during surgery, intracamerally in addition to intracanlicular insertion of drug eluting devices both of which provide extended postoperative prophylaxis and eliminate the need for patients to self-administer topical drops.
Presenting Author
Maria Ant�nia Arteche, MS
Co-Authors
Sara Hira MBBS, Valdez Filho MD, Bernardo Bach MD, Natalia Garcia Gaban MS
Purpose
Posterior capsular rupture (PCR) during cataract surgery increases the risk of postoperative endophthalmitis. It is still unclear if the use of prophylactic intracameral antibiotics (ICA) is beneficial in this scenario. We aimed to assess the efficacy of ICA in patients with PCR to prevent postoperative endophthalmitis.
Methods
A systematic literature search was carried out in PubMed, Embase, and Cochrane for studies comparing the incidence of endophthalmitis in PCR with and without prophylactic intracameral antibiotics. Statistical analysis was performed using R software version 4.3.2. Heterogeneity was assessed with I2 statistics. Subgroup analysis based on the type of ICA was also conducted.
Results
Nine studies consisting of one randomized controlled trial and eight observational studies were included in the meta-analysis. There were a total of 153,690 patients, with 50,207 (33,6%) patients in the ICA group and 103,483 (67.3%) in the No ICA group. There was a significantly lower incidence of endophthalmitis in the ICA group (OR 0.41; 95% CI 0.26 to 0.65; p < 0.001; I� = 9%). Independently, the use of prophylactic intracameral moxifloxacin was also related with a lower risk of endophthalmitis (OR 0.33; 95% CI 0.19 to 0.57; p < 0.001; I2 = 33%).
Conclusion
Our findings suggest that the use of intracameral antibiotics is efficient in preventing postoperative endophthalmitis in patients who had PCR during cataract surgery.
Presenting Author
Harry Levine, MD, MPH
Co-Authors
Kartik Gannamaneni BSc, Jeremy Shapiro BA, Stephen Armenti PhD, MD, Christopher Hood MD, Shahzad Mian MD
Purpose
To determine the safety of an intracanalicular dexamethasone ophthalmic insert (IDOI) and topical Ketorolac tromethamine 0.5% (ketorolac) versus ketorolac and topical prednisolone acetate 1% (PA) over the first month after cataract surgery (POM1) in patients susceptible to increased inflammatory response
Methods
Retrospective study of consecutive uncomplicated cataract surgeries between June 2000 and March 2023 at the Kellogg Eye Center in Michigan, USA. Patients received either IDOI and ketorolac or PA and ketorolac (control) during POM1. Exclusion criteria included history of iritis, intraoperative posterior capsular rupture or vitreous prolapse, premature implant dislodgement, self-taper of steroid drops, or less than 1 month follow up post-operatively. Outcomes included development of breakthrough inflammation necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1.
Results
100 eyes of 78 patients were included in the IDOI/ketorolac group, and 102 eyes of 83 in the control. Demographics, ocular comorbidities, and baseline IOP were comparable. There were no differences between groups in the preoperative presence of epiretinal membrane (38.0% vs 44.1%, p-0.38) or history of diabetic retinopathy (24.0% vs 18.6%; p-0.35) in the surgical eyes. There were no statistical differences in the rates of postoperative rebound inflammation in the IDOI/ketorolac compared to the PA/ketorolac group (2.0% vs 2.0%; p>0.99) or in development of cystoid macular edema (2.0% vs 2.9%; p-0.67). There were no cases of increased IOP >10mmHg at POM1 compared to baseline in either group.
Conclusion
There was no difference in the rate of rebound inflammation or CME in IDOI/ketorolac regimen compared to PA/ketorolac; however, overall, the rate of postoperative complications was low. IDOI can be a safe and effective drop-less alternative to PA/ketorolac therapy after cataract surgery in patients susceptible to increased inflammatory response.
Presenting Author
Itzel Montserrat Perez Gudi�o, MD
Co-Authors
Roberto Gonzalez-Salinas MD, PhD, Ilse Gonz�lez Sanabria MD
Purpose
To compare the efficacy of topical prednisone with adjunctive subconjunctival (SC) dexamethasone versus adjunctive intracameral (IC) triamcinolone versus posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery.
Methods
Prospective study. 114 patients were recruited consecutively and randomized into three groups before surgery. G1: received postoperative topical 1% prednisolone in weekly tapering during 4 weeks with 4 mg/1 mL of adjunctive intraoperative SC dexamethasone; G2: received postoperative topical 1% prednisolone tapering every third day with adjunctive intraoperative 1.2 mg/0.03 ml IC triamcinolone and G3: received a single 20 mg/0.5 ml intraoperative PST triamcinolone acetonide without topical steroids.Central corneal thickness, intraocular pressure,and anterior chamber cells were assessed on days 1, 7 and 28. At week 6 postoperatively, the central macular thickness was evaluated
Results
The mean CCT on postoperative day 1 was 665.6 � 198.8 �m in G1, 688.1�155.2�m in G2, and 662.9�198�m in G3; without being statistically different (p=0.4489)The mean IOP on postoperative day 1 was 16.71�4.099 mmHg in G1,22.14(� 7.574)mmHg in G2, and 15.95(�3.423)mmHg in G3, being significantly higher in G2(p= 0.0268) In G2 triamcinolone crystals persisted for several days in AC, but the mean CCT and IOP on postoperative days 7&28 did not differ between the groups. ACC were <0.5+ postoperative="" days="" 1&7and="" 0="" cells="" were="" observed="" in="" all="" 3="" groups="" day="" 28.="" none="" of="" the="" eyes="" had="" cystoid="" macular="" edema="" in="" the="" 6-week.mean="" central="" macular="" thickness="" had="" no="" significant="" difference="" between="">
Conclusion
Single dose of PST triamcinolone did not yield statistically significant differences compared to traditional topical treatment for controlling post-surgical inflammation. Its use may be a beneficial for uncomplicated surgery particularly in situations where ensuring the administration of eye drops is not feasible
Presenting Author
Namrata Sharma, MD
Co-Authors
Tanuj Dada MD, Jeewan Titiyal MD, Aafreen Bari MD, Tushar Agarwal MD
Purpose
To study the efficacy of intracameral moxifloxacin 0.5% in prevention of post-cataract surgery endophthalmitis
Methods
A multicentric prospective study was conducted in India from January 2017 to December 2023. Twenty four thousand cases undergoing phacoemulsification were randomized in two groups in 1:1 format. Group 1 received intracameral moxifloxacin while group 2 did not receive intracameral antibiotics. They were serially followed up for three months. Any case of endophthalmitis in both groups was documented, managed according to routine protocols and followed up. The microbiological culture, sensitivity and final outcome were noted.
Results
Twenty eyes (20/12000; 0.16%) in intracameral moxifloxacin group developed endophthalmitis as compared to forty-three eyes in control group (43/12000; 0.35%) (p=0.004). The mean time of presentation of endophthalmitis in group 1 was 38.7?25.3 days (median 30 days) and group 2 was 23.63?15.73 days (median 21 days). The number of cases developing fluoroquinolone-resistant endophthalmitis was higher in group 2. At 3 months, 51/63 eyes (80.9%) responded to treatment and endophthalmitis resolved by three months. However, two eyes in group 1 and nine eyes in group 2 (11/63 eyes = 17.4%) developed phthisis.
Conclusion
Intracameral moxifloxacin is effective in preventing post-cataract surgery endophthalmitis.
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