Kuriakose Robin K, Cho Soungmin, Nassiri Saman, Hwang Frank S
Loma Linda University Eye Institute, Loma Linda, CA 92354, USA.
Stanford University Health Medical Center, Palo Alto, CA 94304, USA.
J Ophthalmol. 2022 Jul 19;2022:4857696. doi: 10.1155/2022/4857696. eCollection 2022.
Since the advent of cataract surgery, topical eye drops have been the mainstay of postoperative prophylaxis and treatment. Due to factors such as high expenses and poor patient compliance, there has been a growing interest and acceptance of "dropless" or "less drops" alternatives. The purpose of this study is to compare the effectiveness of intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac to a standard eye drop regimen in controlling postoperative inflammation, corneal edema, and intraocular pressure (IOP) among cataract patients.
A retrospective longitudinal comparative study among 619 consecutive eyes receiving either a standard eye drop regimen, intraoperative triamcinolone acetonide-moxifloxacin, or dexamethasone-moxifloxacin-ketorolac was performed between October 2016 and December 2020. Primary endpoints at postoperative day one (POD1), week one (POW1), and month one (POM1) included corneal edema, anterior chamber inflammation (ACI), and IOP.
Throughout the postoperative time points, there were no significant differences in corneal edema between intravitreal triamcinolone acetonide-moxifloxacin versus the standard eye drop therapy (OR [95% CI]: 1.09 [0.82, 1.45], =0.54) and intracameral dexamethasone-moxifloxacin-ketorolac versus the standard eye drop treatment (OR [95% CI]: 1.22 [0.89, 1.67], =0.22). The postoperative ACI severity was lower in the dexamethasone-moxifloxacin-ketorolac group than in the triamcinolone acetonide-moxifloxacin group by 35% on postoperative day 1 (=0.01). The differences at subsequent postoperative time points were not statistically significant (=0.27 and =1.00 for POW1 and POM1, respectively). IOP at POM1 follow-up visit was statistically significantly higher for the triamcinolone acetonide-moxifloxacin group (mean (±SD): 15.64 (4.26)) than the dexamethasone-moxifloxacin-ketorolac (mean (±SD): 14.16 (4.02)) ( < 0.01). There was no statistical difference in rates of CME (=0.16), and there were no cases of endophthalmitis.
Intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac demonstrate similar levels of efficacy to a standard eye drop regimen after cataract surgery. This study reinforces them as viable alternatives to traditional postoperative drops.
自白内障手术问世以来，局部滴眼液一直是术后预防和治疗的主要手段。由于费用高昂和患者依从性差等因素，人们对“无滴剂”或“少滴剂”替代方案的兴趣和接受度日益增加。本研究的目的是比较玻璃体内注射曲安奈德-莫西沙星和前房内注射地塞米松-莫西沙星-酮咯酸与标准滴眼液方案在控制白内障患者术后炎症、角膜水肿和眼压（IOP）方面的有效性。
在2016年10月至2020年12月期间，对619只连续接受标准滴眼液方案、术中玻璃体内注射曲安奈德-莫西沙星或地塞米松-莫西沙星-酮咯酸的眼睛进行了一项回顾性纵向比较研究。术后第1天（POD1）、第1周（POW1）和第1个月（POM1）的主要终点包括角膜水肿、前房炎症（ACI）和眼压。
在整个术后时间点，玻璃体内注射曲安奈德-莫西沙星与标准滴眼液治疗相比，角膜水肿无显著差异（OR [95% CI]：1.09 [0.82, 1.45]，P = 0.54）；前房内注射地塞米松-莫西沙星-酮咯酸与标准滴眼液治疗相比，角膜水肿也无显著差异（OR [95% CI]：1.22 [0.89, 1.67]，P = 0.22）。地塞米松-莫西沙星-酮咯酸组术后第1天的ACI严重程度比曲安奈德-莫西沙星组低35%（P = 0.01）。术后后续时间点的差异无统计学意义（POW1和POM1时P分别为0.27和1.00）。曲安奈德-莫西沙星组在POM1随访时的眼压在统计学上显著高于地塞米松-莫西沙星-酮咯酸组（平均值（±标准差）：15.64（4.26））（P < 0.01）。黄斑囊样水肿发生率无统计学差异（P = 0.16），且无眼内炎病例。
玻璃体内注射曲安奈德-莫西沙星和前房内注射地塞米松-莫西沙星-酮咯酸在白内障手术后显示出与标准滴眼液方案相似的疗效水平。本研究强化了它们作为传统术后滴眼液可行替代方案的地位。
