Aptel Florent, Colin Cyrille, Kaderli Sema, Deloche Catherine, Bron Alain M, Stewart Michael W, Chiquet Christophe
Department of Ophthalmology, Joseph Fourier University, Grenoble, France.
Pôle IMER, Hospices Civils de Lyon, Lyon, Rhône-Alpes, France.
Br J Ophthalmol. 2017 Nov;101(11):1-10. doi: 10.1136/bjophthalmol-2017-310324. Epub 2017 Aug 3.
Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye's inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines.
在多项随机对照试验(RCT)中对使用皮质类固醇和非甾体抗炎药(NSAIDs)预防和管理术后眼部炎症进行了评估。然而,目前对于不同治疗方案的疗效尚未达成共识,也没有既定的指南。这导致了世界各地不同的实践模式。一项系统文献综述发现,在三项RCT中,对于白内障术后炎症的管理,奈帕芬酸在三项RCT中的三项均产生了积极结果(3/3),酮咯酸(1/1)、溴芬酸(7/7)、氯替泼诺(3/3)和地氟泼尼酯(6/6)也是如此,但氟比洛芬则不然(0/1)。一项单独的研究发现,倍他米松在视网膜脱离(RD)手术后产生的结果不明确;酮咯酸在玻璃体切除术后有效(1/1),但曲安奈德在小梁切除术后无效(0/1)。一项两轮德尔菲调查邀请了28位国际专家对不同眼部手术的炎症潜力及其对不同治疗方案的认同程度进行评分。他们将小梁切除术、RD手术和晶状体玻璃体联合切除术评为比白内障手术炎症性更强。黄斑裂孔或视网膜前膜的玻璃体切除术被认为不比白内障手术炎症性更强。对于小梁切除术,他们倾向于比白内障手术治疗时间更长(NSAID + 皮质类固醇每天三次,持续2个月 vs 1个月)。对于单纯玻璃体切除术、RD手术和晶状体玻璃体联合切除术,专家小组倾向于与白内障手术相同的治疗方案(NSAID + 皮质类固醇每天三次,持续1个月)。专家对于RD和玻璃体视网膜联合手术的首选治疗方案与对眼部炎症状态的认知之间的差异凸显了开展RCT以建立治疗指南的必要性。