Efficacy and Safety of Rimexolone 1% Versus Prednisolone Acetate 1% in the Control of Postoperative Inflammation Following Phacoemulsification Cataract Surgery

PURPOSE: The aim of this study was to evaluate the efficacy and safety of rimexolone 1% ophthalmic suspension compared to that of 1% prednisolone acetate in the control of inflammation in eyes undergoing cataract extraction with phacoemulsification followed by posterior chamber intraocular lens implantation. METHODS: Forty-eight patients who underwent uncomplicated cataract extraction with phacoemulsification followed by posterior chamber IOL implantation constituted the study group of this prospective, randomized, double-masked investigation. Patients were randomly assigned to two treatment groups; rimexolone 1% ophthalmic suspension (27 subjects) or prednisolone acetate 1% (21 subjects). Postoperatively, patients used topical rimexolone or prednisolone drops four times a day for 15 days. Patients were examined at the first postoperative day (day 1), and days 3, 7 and 15. The major efficacy parameters assessed clinically on each visit were anterior chamber cells, anterior chamber flare and conjunctival hyperemia. Safety of the rimexolone was evaluated by IOP values and the presence of adverse effects. RESULTS: Regarding all three efficacy parameters, rimexolone was found to be clinically and statistically equivalent to prednisolone acetate. Intraocular pressure values during the postoperative period were also similar in both groups. CONCLUSION: Rimexolone 1% ophthalmic suspension is both an effective and safe topical steroid in controlling postoperative inflammation after cataract extraction with phacoemulsification.     

Efficacy and safety of 1% rimexolone versus 1% prednisolone acetate in the treatment of anterior uveitis – a randomized triple masked study

Purpose: To evaluate the efficacy and safety of 1% rimexolone versus 1% prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. Methods: A randomised triple masked, parallel comparison of rimexolone and prednisolone acetate ophthalmic suspensions was carried out on 78 patients with acute, chronic and recurrent anterior uveitis. Treatment regimen included instillation of one or two drops of drug one hourly through the waking hours during the first week, two hourly in the second week, four times a day in the third week, two times a day for the first 4 days and once a day for the 3days in the last week. The patient was clinically evaluated on the 3–4th, 7–10th, 14th, 21st and 28th days. The patient was also reviewed on the 30th day. Anterior chamber cells and flare reactions were compared for evaluating the efficacy of the drugs. Result: Rimexolone is as effective as prednisolone acetate ophthalmic suspension in the treatment of anterior uveitis. The largest difference found was 0.1 in the flare reaction (statistically insignificant; p=0.3) and 0.2 score units (statistically significant; p=0.01) in the cells. Overall, comparison of the drugs shows no clinical significance in the treatment of anterior uveitis by either drug. Difference in intraocular pressure (IOP) was also statistically insignificant (p>0.05). However, three patients in the prednisolone acetate group and 1 patient from the rimexolone group showed a rise in IOP. Conclusion: Rimexolone 1% ophthalmic suspension is as effective as and safer than prednisolone acetate 1% ophthalmic suspension in the treatment of anterior uveitis.     

Intracameral triamcinolone acetonide to control postoperative inflammation following cataract surgery with phacoemulsification

Purpose: To explore the efficacy, safety and tolerability of 1 mg intracameral triamcinolone acetonide (TA) in controlling ocular inflammation in patients undergoing cataract surgery. Methods: Sixty eyes of 60 patients undergoing cataract extraction with phacoemulsification at the Department of Ophthalmology, Baskent University School of Medicine were randomized into two groups. After surgery, eyes in group A were injected with 1 mg/0.1 ml TA into the anterior chamber, but eyes in group B were not. Postoperatively; in group B, topical prednisolone acetate 1% eyedrops were administered six times per day for 7 days, then four times per day for 15 days, to control postoperative inflammation. In group A, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells, anterior chamber flare and conjunctival hyperaemia were measured on postoperative days 1, 7 and 30 by slit‐lamp biomicroscopy. The safety of intracameral TA was evaluated by visual acuity measurements, intraocular pressure values and fundus examination. Tolerance variables were assessed by the degree of burning, stinging and blurred vision. Results: Both treatments were equally effective in controlling postoperative inflammation following phacoemulsification. No statistically significant differences between groups were observed for the efficacy, safety and tolerance variables, and no serious adverse events were observed. Conclusions: Intracameral TA of 1 mg can effectively be used to control postoperative inflammation after uncomplicated cataract surgery with phacoemulsification. This makes it possible to decrease the dosage and duration of topical prednisolone acetate.     

Comparison of ketorolac tromethamine 0.5% and loteprednol etabonate 0.5% for inflammation after phacoemulsification: prospective randomized double-masked study.

PURPOSE: To compare the efficacy of a topical nonsteroidal antiinflammatory agent (ketorolac tromethamine ophthalmic solution 0.5%) and a topical steroid (loteprednol etabonate ophthalmic suspension 0.5%) in controlling inflammation after cataract surgery. SETTING: Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Sixty patients were prospectively and randomly assigned to receive topical treatment with ketorolac tromethamine ophthalmic solution 0.5% or loteprednol etabonate ophthalmic suspension 0.5% starting the day after routine phacoemulsification for cataract extraction. Both patient and investigator were masked to treatment. All patients had uneventful small-incision phacoemulsification with placement of a foldable posterior chamber intraocular lens (IOL). Patients used 1 of the 2 antiinflammatory agents 4 times a day starting 24 hours after surgery. Signs and symptoms of inflammation as documented by external slitlamp examination, intraocular pressure (IOP), and Kowa cell and flare measurements were evaluated on postoperative days 1, 4, 7, and 30. RESULTS: There was no statistically significant difference in any measurement of postoperative inflammation between the 2 groups. There was no difference in objective or subjective cell and flare measurements or in IOP between groups. No patient in either group was removed from the study for lack of treatment efficiency. CONCLUSIONS: Ketorolac tromethamine ophthalmic solution 0.5% was as effective as loteprednol etabonate ophthalmic suspension 0.5% in reducing inflammation after routine phacoemulsification and IOL implantation. These results suggest that ketorolac tromethamine 0.5% is a safe and effective antiinflammatory alternative to steroids after cataract extraction.     

Early post-phacoemulsification hypotony as a risk factor for intraocular contamination: in vivo model

PURPOSE: To observe cataract wound dynamics and determine the risk for intraocular contamination under induced conditions of early postoperative hypotony after anterior chamber decompression for high intraocular pressure (IOP) spikes after uneventful phacoemulsification surgery. SETTING: Department of Ophthalmology, Queen's Hospital, Burton-on-Trent, United Kingdom. METHODS: In a prospective case series, 30 patients were treated with anterior chamber decompression for elevated IOP (>35 mm Hg) 1 to 2 hours after uneventful phacoemulsification through clear corneal temporal incisions. A drop of 2% fluorescein was instilled in the conjunctival sac before aqueous release to study the ocular fluid movements during and after the decompression procedure. The patterns of fluorescein movement were observed and photographed under cobalt blue light. RESULTS: Fluorescein staining of the entire corneal tunnel was observed in all 30 eyes after decompression. An immediate fluorescein flare was observed in the anterior chamber after aqueous release in 24 eyes (80%) (P<.001). Observations over several seconds after decompression found a frank influx of fluorescein-stained fluid into the anterior chamber in 12 eyes (40%) (P<.001), giving rise to an "inverse Seidel's test." An intermittent ingress of fluorescein-stained fluid continued for several minutes after the procedure in 6 eyes (20%) (P<.05). CONCLUSIONS: An incompetence of clear corneal cataract wound with intraocular contamination was observed during the period of induced hypotony after anterior chamber decompression in the early post-phacoemulsification period.     

A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification

Purpose:To compare the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification.Methods:All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti-inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative-free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery.Results:At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively).Conclusion:NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti-inflammatory agent in patients with uneventful phacoemulsification.     

Comparison of the efficacy and safety of ketorolac tromethamine 0.5% and prednisolone acetate 1% after cataract surgery.

PURPOSE: To compare the anti-inflammatory and analgesic efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution with those of prednisolone acetate 1% in patients having cataract surgery. SETTING: Shawnee Mission Eye Care, Shawnee Mission, Kansas, USA. METHODS: This double-blind, randomized, single-site study comprised 59 healthy men and women with a clinical diagnosis of routine ocular cataract requiring surgical removal. All patients had extracapsular cataract extraction and posterior chamber intraocular lens implantation. After surgery, patients were randomized to receive ketorolac tromethamine 0.5% or prednisolone acetate 1%, self-instilled in the treated eye, according to the following schedule: 1 to 2 drops 4 times daily (week 1); 3 times daily (week 2); 2 times daily (week 3); once daily (week 4). Patients were examined postoperatively on days 1, 7, and 28. Intraocular anti-inflammatory efficacy was assessed by lid edema, lid injection, conjunctival injection, corneal edema, ciliary flush, and anterior chamber cells. Analgesic efficacy was assessed by patient self-rated pain severity, pain frequency, total symptom sum, and overall global improvement. RESULTS: Both treatments produced comparable reductions in intraocular inflammation and pain after cataract surgery and were well tolerated by patients. No adverse events were reported, and there were no significant changes in intraocular pressure in either group. Improvements in visual acuity were also similar in both groups. CONCLUSION: Ketorolac tromethamine 0.5% ophthalmic solution was as effective and well-tolerated as prednisolone acetate 1% solution in controlling postoperative inflammation and pain after cataract surgery.     

Comparison of ketorolac tromethamine 0.5% and rimexolone 1% to control inflammation after cataract extraction. Prospective randomized double-masked study

PURPOSE: To compare the efficacy of a topical nonsteroidal anti-inflammatory agent (ketorolac tromethamine 0.5%) with that of a topical steroid (rimexolone 1%) to control inflammation after cataract surgery. SETTING: Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Thirty-six patients were prospectively and randomly assigned to receive topical treatment with either ketorolac tromethamine 0.5% or rimexolone 1% starting the day after routine cataract extraction. Treatment was masked to both patient and investigator. Each patient had uneventful small incision phacoemulsification with placement of a foldable posterior chamber intraocular lens. Patients used 1 of the 2 antiinflammatory agents 4 times each day starting 24 hours after surgery. No antiinflammatory medications were used preoperatively, intraoperatively, or for 24 hours postoperatively. Signs and symptoms of inflammation, intraocular pressure (IOP), and Kowa cell and flare measurements were evaluated 1, 4, 7, and 30 days postoperatively. RESULTS: There was no statistically significant difference in any measurement of postoperative inflammation between the 2 groups. There was no difference in objective or subjective cell and flare measurements. In addition, there was no difference in IOP measurements between groups. CONCLUSIONS: Ketorolac tromethamine 0.5% was as effective as rimexolone 1% in reducing inflammation after cataract surgery. These results suggest that ketorolac tromethamine 0.5% is a safe and effective antiinflammatory alternative to steroids after cataract extraction.     

Comparison of prednisolone 1%, rimexolone 1% and ketorolac tromethamine 0.5% after cataract extraction

Purpose To compare the efficacy, safety and patient comfort of two topical steroids (prednisolone 1% and rimexolone 1%) and a topical non-steroidal anti-inflammatory agent (ketorolac tromethamine 0.5%) after extracapsular cataract extraction.Methods Forty-five patients were enrolled in this prospective, randomized, double-blind study. They were assigned to receive topical treatment with either prednisolone, rimexolone or ketorolac tromethamine ophthalmic solution after phacoemulsification for cataract extraction. On postoperative days 1, 3, 5, 14 and 28 best-corrected visual acuity, intraocular pressure (IOP), slit-lamp examination of the anterior segment and report of the patients comfort were assessed and compared by Friedman rank time analysis.Results Regarding the primary outcome efficacy of inflammation control the assessment of cells did not differ (p=0.165), while flare in the anterior chamber was lowest (p=0.008) in the non-steroidal anti-inflammatory drug (NSAID) group. Surface inflammation was lowest with prednisolone (p=0.002). Regarding safety, visual acuity did not differ among the groups. In the prednisolone group one patient, however, responded to steroid treatment with elevated IOP and had to be excluded. In the remaining patients IOP was even lower in the two steroidal treatment groups than with ketorolac (p=0.030). One patient receiving ketorolac had to be excluded because a corneal erosion developed. Patient comfort was highest with prednisolone (p=0.041).Conclusions Ketorolac tromethamine provides good control of intraocular inflammation after cataract extraction without the risk of a steroidal IOP increase, which was also not observed under rimexolone therapy. The best surface inflammation control and patient comfort was observed with prednisolone, which remains a good choice.The authors have no proprietary interest in any of the equipment or materials used in this study.     

老年性白内障术中前房注射不同剂量曲安奈德预防炎症反应的研究

目的探讨老年性白内障术中前房注射不同浓度曲安奈德（TA）控制术后炎症反应的效果。方法老年性白内障手术60例（60眼）,随机分为3组,每组20眼。A组在手术结束时向前房内注射TA0．1mg／0．2mL;B组前房内注射rrA0．2mg／0．2mL。A、B组术后滴妥布霉素滴眼液,4次／d,连用1周。C组（对照组）,手术结束时前房内注射灌注液,术后滴妥布霉素地塞米松滴眼液,4次／d,连用3周。术后随访1个月。术后6～8h测量眼压,术后1d、2d、7d、15d、30d观察前房细胞及房水闪光,测量眼压、检查视力及眼底。结果术后1d、2d、7d、15d、30d,3个组之间前房细胞比较（P=1）,房水闪光比较（P=1）,差异均无统计学意义,术后6～8h,1d、2d、7d、15d、30d,3个组之间眼压比较,差异无统计学意义。结论老年性白内障术中前房注射0．1mg／0．2mL或0．2mg／0．2mL的曲安奈德都能有效地控制术后的炎症反应,无明显不良影响,重要的是术后可以不用糖皮质激素,从而减少了频繁滴眼的麻烦,也避免了由其引起的并发症。     

Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery

PURPOSE: To compare the efficacy and tolerance of piroxicam 0.5% ophthalmic solution and diclofenac sodium 0.1% ophthalmic solution in controlling inflammation after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Ophthalmological Department, San Donà di Piave Hospital, Venice, Italy. MATERIALS AND METHODS: Forty consecutive patients--18 men and 22 women--between 55 and 85 years of age (mean age, 75.1 +/- 7.12 years) who were scheduled for cataract extraction with phacoemulsification and IOL implantation were randomized to receive 0.5% piroxicam ophthalmic solution (piroxicam group, 20 patients) or 0.1% diclofenac sodium ophthalmic solution (diclofenac group, 20 patients) for 1 month postoperatively. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) measurements and slit-lamp biomicroscopy for the evaluation of corneal edema, Descemet membrane folds, Tyndall, and cells in the anterior chamber were carried out in all patients 1 day, 4 days, and 1 month postoperatively. Subjective symptoms after the nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution instillation were assessed using a questionnaire. RESULTS: There were no significant differences between the two groups in postoperative IOP, BCVA, anterior chamber flare and cell levels, corneal edema, or Descemet membrane folds. Ocular discomfort, evaluated as burning or stinging sensation after NSAID ophthalmic solution instillation, was significantly more frequent and intense in the diclofenac-treated eyes. Two eyes in the diclofenac group had a mild transient punctate keratitis. CONCLUSIONS: These results suggest that piroxicam is as effective as diclofenac sodium in preventing inflammation after cataract surgery with IOL implantation, and its better tolerance and safety can provide higher patient compliance.     

Anti-inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide versus prednisolone acetate 1% eyedrops after pars plana vitrectomy

PURPOSE: To compare the safety and anti-inflammatory efficacy of a single posterior subtenon injection of triamcinolone acetonide (TA) with prednisolone acetate 1% eyedrops after pars plana vitrectomy (PPV). METHODS: The study included 40 consecutive phakic eyes of 40 patients undergoing PPV for non-clearing vitreous haemorrhage with attached retina (verified by echography), epiretinal membrane or macular hole. At the end of the surgical procedure, eyes were randomized to receive either a single posterior subtenon injection of TA (40 mg in 1 ml) plus sham eyedrops (prednisolone acetate 1% vehicle) postoperatively (group TA), or a posterior subtenon sham injection (1 ml balanced salt solution) plus prednisolone acetate 1% eyedrops postoperatively (group ED). RESULTS: There was no difference in the severity of anterior chamber cell and flare between the two groups at any time-point during the study period (p > 0.05). Separate within-group analysis revealed a significant decrease in anterior chamber cell and flare from postoperative day 1 to postoperative days 7, 14 and 28 in both groups (p < 0.05). There was no difference in pain, photophobia, conjunctival erythema, ciliary flush or chemosis scores between the two groups at any time-point during the study period (p > 0.05). Steroid-induced intraocular hypertension was not observed in either group. CONCLUSIONS: A single posterior subtenon injection of TA can be as effective and safe as a 4-week regimen of prednisolone acetate 1% eyedrops in controlling intraocular inflammation after PPV.     

内眼手术前,后结膜囊细菌学研究

目的:探索眼科内眼手术前后结膜囊细菌学变化特点及临床眼科用药效果。方法:133眼需要行内眼手术的连续病例包括白内障手术68眼、青光眼手术39眼、视网膜脱离手术20眼、玻璃体切割术6眼。用133眼内眼手术病人手术前后的结膜刮片及68眼白内障手术术毕的前房冲洗液作细菌培养,并作药敏试验。结果:133眼内眼手术患者入院时结膜刮片作细菌培养有61眼(45.85％)培养出细菌,其中金黄色葡萄球菌23眼、表皮葡萄球菌25眼、G~ 杆菌13眼;手术消毒前结膜囊刮片有8眼(6％)仍培养出细菌,其中金黄色葡萄球菌3眼,表皮葡萄球菌5眼;68眼白内障手术患者前房冲洗液中仅1眼(1.5％)培养出细菌,为表皮葡萄球菌;术毕时结膜刮片4眼(3％)培养出细菌,所培养出来的细菌均对妥布霉素、庆大霉素、先锋Ⅵ、万古霉素和利福平敏感,而对四环素、氯霉素、红霉素、氧氟沙星耐药。结论:肉眼手术前应用有效抗菌素至为重要,可预防眼内炎的发生,但不可轻视手术无菌操作。眼科学报1999;15:267-269。     

Inflammatory response after phacoemulsification treated with 0.5% prednisolone acetate or vehicle

Purpose  To compare the inflammatory response after phacoemulsification and intraocular lens implantation, using postoperative treatment with 0.5% prednisolone acetate eye drops or vehicle. Design  A multi-center randomized double-masked vehicle-controlled, parallel group phase IV study. Methods  Sixty-two eyes of 62 patients undergoing phacoemulsification were examined at five German university eye hospitals (Mainz, Heidelberg, Bonn, Erlangen, Frankfurt/Main). Patients received either 0.5% prednisolone acetate eye drops (group 1) or vehicle eye drop solution (group 2) four times a day until day 2, then open-label treatment with 0.5% prednisolone acetate eye drops four times a day continued until day 14 for all patients. Postoperative inflammation was evaluated by using laser flare photometry. Secondary efficacy variables included visual acuity, intraocular pressure, corneal edema, bulbar conjunctival hyperemia and ocular discomfort. Results  In group 1, median flare rose from 7.4 photon counts/ms preoperatively to 31.0 photon counts/ms at day 1. In group 2, the flare increased from 8.6 photon counts/ms preoperatively to 30.5 photon counts/ms at day 1. The differences between the groups were not statistically significant. At day 3, flare measures were reduced in group 1 but remained fairly unchanged in group 2 (20.8 photon counts/ms vs 32.6 photon counts/ms), which was statistically significant (p = 0.0055). At day 14, photon counts were comparable in both groups (13.0 photon counts/ms vs 11.4 photon counts/ms), respectively. Both groups were comparable regarding secondary efficacy variables. Conclusions  0.5% prednisolone acetate appeared to be significantly more effective as vehicle in controlling intraocular inflammation after phacoemulsification; both groups had a similar safety profile. Clinical Trials.gov Identifier: NCT00170729     

Intraoperative intraocular triamcinolone injection prophylaxis for post-cataract surgery fibrin formation in uveitis associated with juvenile idiopathic arthritis

PURPOSE: To assess the efficacy of a single intraoperative intraocular injection of triamcinolone acetonide during cataract surgery to prevent postoperative fibrin formation in patients with iridocyclitis associated with juvenile idiopathic arthritis. SETTING: Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany. METHODS: The charts of 22 patients (16 girls and 6 boys) with juvenile idiopathic arthritis and chronic iridocyclitis having lensectomy and anterior vitrectomy were retrospectively reviewed. In 12 patients (14 eyes), triamcinolone acetonide 4 mg was injected into the anterior chamber at the end of the surgery (triamcinolone group). Another 10 patients (13 eyes) received an intraoperative intravenous injection of methylprednisolone and postoperative oral prednisolone (systemic treatment group). No intraocular lenses were implanted. Postoperatively, prednisolone acetate 1% eyedrops were given. The main problems included intraocular inflammation, the need for additional systemic corticosteroids, and intraocular pressure (IOP) elevation. RESULTS: The mean patient age was 10.6 years +/- 3.1 (SD) in the triamcinolone group and 7.4 +/- 2.7 years in the systemic treatment group. The mean follow-up was 9.9 +/- 3.6 months and 10.9 +/- 1.2 months, respectively. All patients were taking systemic immunosuppression before surgery, and the medication was continued postoperatively. Fibrin formation was not seen after surgery in the triamcinolone group but occurred in 5 patients in the systemic treatment group (P = .02). Additional systemic corticosteroids were not required in the triamcinolone group. All patients had visual acuity improvement. No increase in IOP was noted after the triamcinolone acetate injections. CONCLUSIONS: Intraoperative intraocular injection of 4 mg of triamcinolone acetonide may be more effective than intraoperative intravenous methylprednisolone and additional postoperative short-term oral prednisolone in preventing postoperative fibrin formation after cataract surgery in patients with juvenile idiopathic arthritis and iridocyclitis.     

Evaluation of 0.4% ketorolac tromethamine ophthalmic solution versus 0.5% ketorolac tromethamine ophthalmic solution after phacoemulsification and intraocular lens implantation.

PURPOSE: The aim of this study was to compare the effectiveness and patient tolerance of 0.4% ketorolac tromethamine ophthalmic solution and 0.5% ketorolac tromethamine ophthalmic solution after routine phacoemulsification and lens implantation. Setting: The setting for this study was the Storm Eye Institute and Magill Research Center for Vision Correction, Medical University of South Carolina (Charleston, SC). METHODS: This work was a prospective, double-masked study that included 40 eyes of 40 patients randomly assigned to receive topical treatment with 0.4% ketorolac or 0.5% ketorolac, starting 15 min prior to routine phacoemulsification and foldable posterior chamber intraocular lens implantation. Following the procedure, patients were instructed to use the assigned treatment agent 4 times a day after surgery for 1 week and twice a day for 3 weeks, when drops were discontinued. Slit-lamp examination, intraocular pressure (IOP), laser cell and flare measurements, and subjective patient tolerance were evaluated postoperatively at 1, 7, and 30 d. Comparisons between the 2 groups were made at each visit, as well as comparisons to baseline. A P=value less than .05 was considered statistically significant. RESULTS: At day 1, a higher percentage of patients (70% vs. 40%) reported symptoms (mainly foreign body sensation and stinging/burning) in the 0.5% ketorolac group, compared to the 0.4% ketorolac group. No significant differences were found between the 2 groups over time regarding best-corrected visual acuity (BCVA), IOP, slit-lamp assessment of cells, and cell and flare measured using the laser cell/flare meter. CONCLUSIONS: Treatment with 0.4% ketorolac tromethamine ophthalmic solution is as effective as 0.5% ketorolac tromethamine ophthalmic solution in reducing inflammation after routine cataract surgery. Patients reported less discomfort using 0.4% ketorolac.     

白内障超声乳化术治疗急性闭角型青光眼合并白内障

了解白内障超声乳化术治疗急性闭角型青光眼合并白内障的有效性。 方法:对2006-03-01/2010-10-31收治的急性闭角型青光眼合并白内障患者47例51眼,眼压稳定后行超声乳化联合人工晶状体植入术,术后均随访1~3a。 结果:术后47例51眼中44例48眼眼压下降,术前眼压22.98±3.22mmHg,术后眼压13.24±3.17mmHg(P<005),45例49眼视力较术前明显提高(P<0.05)。47例51眼术后前房深度加深,由术前1.542±0.314mm转为术后3.157±0.243mm(P<0.05)。 结论:白内障超声乳化术可以使急性闭角型青光眼前房加深,不同程度地开放已关闭的房角,改善周边窄房角的解剖状态,降低瞳孔阻滞后周边前房关闭的可能性,可以使升高的眼压下降,提高视力,是闭角型青光眼合并白内障患者安全有效的治疗途径。     

Comparison of the effect of Viscoat and DuoVisc on postoperative intraocular pressure after small-incision cataract surgery

PURPOSE: To evaluate the effect of Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) and DuoVisc (Viscoat and Provisc [sodium hyaluronate 1%]) on postoperative intraocular pressure (IOP) after bilateral small-incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 60 eyes of 30 consecutive patients with age-related cataract in both eyes. Each patient's eyes were randomly assigned to receive Viscoat or DuoVisc during cataract surgery. DuoVisc is a packet containing 2 ophthalmic viscosurgical devices (OVDs): the dispersive Viscoat, which was used for intraocular lens (IOL) implantation. In the Viscoat group, the Viscoat was used during the entire surgery. The intraocular pressure (IOP) was measured preoperatively as well as 1, 6, and 20 to 24 hours postoperatively. RESULTS: One and 6 hours postoperatively, the mean IOP was significantly higher in the Viscoat group than in the DuoVisc group (25.8 mm Hg and 20.5 mm Hg, respectively, at 1 hour and 24.7 mm Hg and 21.1 mm Hg, respectively, at 6 hours) (P<.05). At 20 to 24 hours, the mean IOP was not statistically significantly different between the 2 groups. Intraocular pressure spikes to 30 mm Hg or higher occurred in 4 eyes in the DuoVisc group and 11 eyes in the Viscoat group (P<.05). CONCLUSIONS: Viscoat caused significantly higher IOP increases and significantly more IOP spikes than DuoVisc in the early postoperative period. Therefore, if Viscoat is used during cataract surgery, an additional cohesive OVD should be used for IOL implantation.     

Fuchs综合征并发白内障术后炎症反应的定量监测

目的 定量分析Fucha综合征患者白内障手术后炎症反应程度,为合理控制炎症提供客观依据.方法 回顾性病例对照研究.对2008年7月至2009年12月在中山眼科中心就诊的11例Fuchs 综合征并发白内障患者(11只眼)和11例(11只眼)对照组(年龄相关性白内障和先天性白内障患者)行超声乳化白内障吸除联合人工晶状体植入术,并用激光蛋白细胞检测仪观察手术前及手术后第1、7、30 d和90 d房水闪辉和房水细胞值.结果 手术后第1天两组患者房水闪辉和房水细胞值显著增高,随后缓慢下降.Fuchs综合征患者组在手术前后不同时期,其房水闪辉和房水细胞值都高于对照组.但是两组患者房水闪辉和房水细胞值均于术后90 d恢复术前水平.结论 Fuchs综合征患者白内障手术后眼内炎症反应持续时间短,激光蛋白细胞检测仪可以精确定量评估眼内炎症反应程度,正确指导临床合理控制炎症.

Abstract：

Objective To quantify the intraocular inflammation following phacoemulsification with posterior chamber lens implantation in eyes with Fuchs' heterochromic uveitis (FHU). Methods In this prospective study, 11 eyes of 11 patients with FHU (mean aged 31.6 years) and 11 eyes of 11patients with age-related cataract or congenital cataract (mean aged 42.1 years) underwent phacoemulsification with posterior chamber lens implantation. Aqueous flare and cells were quantified using the laser flare-cell meter (LFCM) following medical pupillary dilation preoperatively and 1, 7, 30 and 90days postoperatively. Results Highly statistically significant differences in flare value were demonstrated in patients with FHU vs. controls at 1, 7, and 30 days after surgery. On 1 day and 7 days post-surgery, cell counts were significantly increased in the FHU group compared to the control group,while no statistical differences were apparent 30 or 90 days after surgery. Conclusions Our data indicate that postoperative intraocular inflammation is relatively mild in eyes with FHU and measurement Of aqueous flare and cell count by laser flare-cell photometer is an objective method to determine intraocular inflammation following cataract surgery in eyes with FHU.     

复合式小梁切除术后眼压不降的病因分析

目的：探讨复合式小梁切除术后眼压不降的病因。

方法：记录患者第一次手术前、术中及术后的各种情况,发生眼压不降时眼部专科检查(眼压、视力、房角等)及UBM检查等,回顾分析2009-09/2010-12复合式小梁切除术后眼压不降30例34眼的病因。

结果：复合式小梁切除术后眼压不降的病因：滤过泡扁平瘢痕化12例15眼,恶性青光眼倾向5例6眼,术后前房出血3例3眼,巩膜瓣内切口欠通畅2例2眼,术前高眼压持续时间长2例2眼,包裹性滤过泡2例2眼,术前葡萄膜炎1例1眼,术后膨胀期白内障1例1眼,手术操作不良1例1眼,手术方式选择欠妥1例1眼。

结论：复合式小梁切除术后眼压不降主要原因是术后滤过泡扁平瘢痕化。