Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy.
Department of Ophthalmology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur J Ophthalmol. 2021 Mar;31(2):287-290. doi: 10.1177/1120672120963458. Epub 2020 Oct 20.
Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.
白内障手术是全球最常施行的择期手术。尽管被认为是安全的手术，但仍有可能发生潜在致盲的不良事件。其中，术后炎症和感染最为相关。抗炎药物，如皮质类固醇，以及局部抗生素，是治疗炎症和预防感染的主要药物。然而，关于局部抗生素预防和皮质类固醇治疗的持续时间仍然存在不确定性。LEADER7 是一项最近进行的国际临床研究，该研究使用左氧氟沙星和地塞米松固定组合滴眼液治疗行单纯白内障手术的患者，发现 1 周局部抗生素预防与临床实践中常用的 2 周疗程同样有效。该研究还表明，地塞米松治疗 1 周可使超过 85%的患者炎症体征和症状完全消退，因此不需要进一步延长皮质类固醇治疗。这种新的治疗策略可以代表在减少白内障手术后不合理使用预防性抗生素方面向前迈出的重要一步，限制细菌耐药性的出现，并为优化皮质类固醇治疗的使用和安全性提供机会。
