Haq Zeeshan, Zhang Michael H, Benjamin Mark J, Riaz Kamran M
Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA.
Benjamin Eye Care Center, La Grange, IL, USA.
Clin Ophthalmol. 2020 Apr 23;14:1117-1125. doi: 10.2147/OPTH.S247739. eCollection 2020.
To compare short-term non-infectious clinical outcomes after cataract surgery with an intraoperative pars plana intravitreal antibiotic-steroid (IVAS) injection of triamcinolone, moxifloxacin, and vancomycin (TMV) versus a standard postoperative topical regimen.
A retrospective comparative case series of 1058 eyes (control = 487, treatment = 571) undergoing cataract surgery were included. Endpoints included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the unplanned use of anti-inflammatory topical medication in the postoperative period. The follow-up period ranged from 1 to 6 months.
A final monocular BCVA of 20/25 or better was achieved in 78.8% and 87.4% of eyes in the control and treatment groups, respectively (p = 0.001). The overall incidence of an IOP spike (Δ ≥ 10 mm Hg) was not significantly different between the two groups (0.4% versus 1.9%, p = 0.027). The rates of persistent anterior chamber inflammation (PACI), rebound anterior chamber inflammation (RACI), and cystoid macular edema (CME) in the control and treatment groups were 8.0% vs 2.6% (p < 0.001), 6.4% vs 2.6% (p = 0.003), and 3.9% vs 4.7% (p = 0.511), respectively. The use of an IVAS injection of TMV conferred an increased risk of CME (odds ratio [OR] = 3.21, 95% confidence interval [CI] = 1.42 to 7.23) but no significant effect on the risk of PACI (OR = 0.34, 95% CI = 0.10 to 1.14) or RACI (OR = 0.52, 95% CI = 0.18 to 1.54) when compared to a topical regimen.
An intraoperative IVAS injection after uncomplicated cataract surgery may be as safe and effective as a standard topical regimen in terms of postoperative IOP and anterior chamber inflammatory events, respectively. However, the efficacy of a TMV formulation for CME prophylaxis appears to be unsatisfactory. Future studies with prospective and randomized designs are needed to further evaluate this technique.
比较白内障手术中经睫状体平坦部玻璃体内注射曲安奈德、莫西沙星和万古霉素（TMV）的术中玻璃体内抗生素 - 类固醇（IVAS）注射与标准术后局部用药方案后的短期非感染性临床结局。
纳入1058只接受白内障手术的眼睛的回顾性比较病例系列（对照组 = 487只，治疗组 = 571只）。观察终点包括最佳矫正视力（BCVA）、眼压（IOP）以及术后非计划使用局部抗炎药物的情况。随访期为1至6个月。
对照组和治疗组分别有78.8%和87.4%的眼睛最终单眼BCVA达到20/25或更好（p = 0.001）。两组眼压峰值（Δ≥10 mmHg）的总体发生率无显著差异（0.4%对1.9%，p = 0.027）。对照组和治疗组持续性前房炎症（PACI）、复发性前房炎症（RACI）和黄斑囊样水肿（CME）的发生率分别为8.0%对2.6%（p < 0.001）、6.4%对2.6%（p = 0.003）和3.9%对4.7%（p = 0.511）。与局部用药方案相比，TMV的IVAS注射增加了CME的风险（优势比[OR] = 3.21，95%置信区间[CI] = 1.42至7.23），但对PACI风险（OR = 0.34，95% CI = 0.10至1.14）或RACI风险（OR = 0.52，95% CI = 0.18至1.54）无显著影响。
在术后眼压和前房炎症事件方面，单纯性白内障手术后术中IVAS注射可能与标准局部用药方案一样安全有效。然而，TMV制剂预防CME的疗效似乎并不理想。需要进一步开展前瞻性随机设计研究以评估该技术。
