Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Shamir Medical Center, Be'er Ya'akov, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland.
Am J Ophthalmol. 2020 Jul;215:104-111. doi: 10.1016/j.ajo.2020.02.007. Epub 2020 Feb 14.
To assess the role of anti-inflammatory medication following cataract surgery on the formation of posterior capsular opacification.
Cohort study.
A retrospective registry analysis of 25,818 consecutive patients who underwent cataract surgery between the years 2014 and 2018 at Helsinki University Hospital in Finland. Nd:YAG laser capsulotomy rates were compared between patients treated postoperatively with topical steroids, nonsteroidal anti-inflammatory medications (NSAIDs), or their combination. Kaplan-Meier and Cox regression analyses were used. A single eye of each patient was included. Main outcomes were confirmed against a second independent dataset.
A total of 13,368 patients were included in the analysis, with a mean age of 73.2 ± 9.7 years; 61.7% were female. Pseudoexfoliation was noted in 10.1% of cases. The mean follow-up time was 22.8 ± 15.7 months. Patients were treated with steroid monotherapy (28.9% of cases), NSAID monotherapy (62.2%), or a combination of both (8.9%). Treatment with steroids resulted in significantly lower Nd:YAG capsulotomy rates compared to NSAIDs (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62-0.93, P = .009). Treatment with combination therapy of steroids and NSAIDs showed no added benefit over steroid monotherapy (HR 1.11, 95% CI 0.68-1.80, P = .674). Cox regression analysis adjusted for patients' age, sex, pseudoexfoliation, and risk stratification remained significantly predictive for lower capsulotomy rates with steroid treatment over NSAIDs (HR 0.70, 95% CI 0.52-0.88, P = .001).
Postoperative treatment with steroids among patients undergoing uncomplicated cataract surgery was associated with lower rates of clinically significant posterior capsule opacification compared to treatment with NSAIDs alone. Combination therapy of steroids and NSAIDs had no added benefit over steroids alone.
评估白内障手术后抗炎药物对后囊混浊形成的作用。
队列研究。
对 2014 年至 2018 年间在芬兰赫尔辛基大学医院接受白内障手术的 25818 例连续患者进行回顾性登记分析。比较术后接受局部皮质类固醇、非甾体抗炎药（NSAIDs）或两者联合治疗的患者的 Nd：YAG 后囊切开术率。使用 Kaplan-Meier 和 Cox 回归分析。每位患者的单眼均纳入分析。主要结局与第二个独立数据集进行了确认。
共纳入 13368 例患者，平均年龄为 73.2 ± 9.7 岁；61.7%为女性。10.1%的病例存在假性剥脱症。平均随访时间为 22.8 ± 15.7 个月。患者接受皮质类固醇单药治疗（28.9%的病例）、NSAID 单药治疗（62.2%）或两者联合治疗（8.9%）。皮质类固醇治疗的 Nd：YAG 后囊切开术率明显低于 NSAIDs（风险比 [HR] 0.76，95%置信区间 [CI] 0.62-0.93，P =.009）。皮质类固醇和 NSAIDs 联合治疗与皮质类固醇单药治疗相比无额外获益（HR 1.11，95%CI 0.68-1.80，P =.674）。调整患者年龄、性别、假性剥脱症和风险分层的 Cox 回归分析表明，皮质类固醇治疗与 NSAIDs 治疗相比，后囊混浊发生率显著降低（HR 0.70，95%CI 0.52-0.88，P =.001）。
与单独使用 NSAIDs 相比，在接受单纯白内障手术的患者中，术后使用皮质类固醇治疗与较低的临床显著后囊混浊发生率相关。皮质类固醇和 NSAIDs 的联合治疗与单独使用皮质类固醇相比没有额外的益处。
