Assil Eye Institute, Beverly Hills, California.
Vance Thompson Vision, Fargo, North Dakota.
Curr Opin Ophthalmol. 2021 Jan;32 Suppl 1:S1-S12. doi: 10.1097/ICU.0000000000000708.
Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience.
Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis.
Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.
目的综述：药理学的进步使我们在围手术期能够避免局部药物治疗，而不会影响抗炎和抗菌的覆盖范围。在本次综述中，我们将介绍无滴剂白内障手术的基础，旨在改善手术结果和患者体验。
最近发现：超声乳化手术的结果在很大程度上取决于外科医生的技术水平，但也取决于是否遵守复杂的多药物围手术期抗炎和抗菌治疗方案，以预防威胁视力的并发症，如黄斑囊样水肿或眼内炎。由于不遵医嘱、滴眼困难、生物利用度和副作用等原因，这种方案的成功实施可能会受到限制。最近，地塞米松的缓释制剂得到了发展，一种是经巩膜睫状体沟给药的植入剂，另一种是眼内悬浮剂，可以提供持续递减剂量的地塞米松，同时减少或消除对抗炎滴眼剂治疗的需求。同样，越来越多的证据有力地证明，在白内障超声乳化术中使用眼内抗生素与局部使用抗生素预防眼内炎同样有效。
总结：在白内障超声乳化术中联合使用缓释地塞米松和眼内抗生素，可以提供抗菌和抗炎预防，而无需局部滴眼药物。这种方法有可能提高治疗的依从性、视力结果和整体患者体验。
