Shapiro Jeremy N, Armenti Stephen T, Levine Harry, Hood Christopher T, Mian Shahzad I
Kellogg Eye Center and Department of Ophthalmology and Visual Sciences (J.N.S., H.L., C.T.H., S.I.M.), University of Michigan, Ann Arbor, Michigan, USA.
Scheie Eye Institute and Department of Ophthalmology (S.T.A.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2024 Dec;268:174-180. doi: 10.1016/j.ajo.2024.07.030. Epub 2024 Jul 31.
To compare the efficacy of an intracanalicular dexamethasone intracanalicular insert (DII) to a topical prednisolone acetate 1% taper for preventing breakthrough inflammation (iritis or cystoid macular edema [CME]) during the first postoperative month (POM1) after cataract surgery.
Retrospective, nonrandomized comparative interventional study.
Patients received either DII or topical prednisolone acetate 1% eyedrops (control) during POM1. Exclusion criteria included history of iritis, glaucoma, intraoperative posterior capsular rupture or vitreous prolapse, immediate postoperative anterior chamber inflammation requiring treatment, or less than 1 month follow-up postoperatively. Outcomes included development of breakthrough inflammation after >3 days postoperatively necessitating additional antiinflammatory drops, CME, and increased intraocular pressure (IOP) at POM1.
A total of 266 eyes of 174 patients were included in the DII group and 258 eyes of 167 patients in the control group. Demographics, comorbidities, and baseline IOP were comparable between groups. The breakthrough inflammation rate was significantly higher in the DII group compared to control (9.0% vs 3.1%; P < .01); CME rates were similar between groups (4.9% vs 4.3%; P = .75). There were no cases of increased IOP >10 mm Hg at POM1 compared to baseline in either group.
After cataract surgery, DII demonstrated a higher rate of breakthrough inflammation than a standard topical steroid regimen with no significant differences in CME rate or IOP increase; however, overall, the rate of postoperative complications was low. DII can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery.
比较泪小管地塞米松泪小管插入物（DII）与1%醋酸泼尼松龙局部递减疗法预防白内障手术后第一个月（术后第1个月，POM1）内的炎症复发（虹膜炎或黄斑囊样水肿[CME]）的疗效。
回顾性、非随机对照干预研究。
患者在POM1期间接受DII或1%醋酸泼尼松龙滴眼液（对照组）治疗。排除标准包括虹膜炎病史、青光眼、术中后囊破裂或玻璃体脱出、术后即刻前房炎症需要治疗或术后随访时间少于1个月。观察指标包括术后3天以上出现炎症复发需要额外使用抗炎滴眼液、CME以及POM1时眼压升高。
DII组纳入174例患者的266只眼，对照组纳入167例患者的258只眼。两组患者的人口统计学、合并症和基线眼压具有可比性。DII组的炎症复发率显著高于对照组（9.0%对3.1%；P <.01）；两组的CME发生率相似（4.9%对4.3%；P =.75）。两组在POM1时与基线相比，均未出现眼压升高>10 mmHg的病例。
白内障手术后，DII的炎症复发率高于标准局部类固醇治疗方案，CME发生率或眼压升高无显著差异；然而，总体而言，术后并发症发生率较低。DII可作为白内障手术后局部皮质类固醇治疗的一种安全有效的替代方法。
