Even with all the advances in surgical techniques and drug formulations, the prevention and management of postoperative ocular inflammation still remains a challenge.
To better understand anti-inflammatory drug use, Prof. Florent Aptel, M.D., Ph.D., and colleagues at the University Hospital of Grenoble in France, published their systematic review of the literature and a Delphi survey of 28 international experts in the British Journal of Ophthalmology.
Prof. Aptel explains the purpose for initiating this study: “Interestingly, despite the very large number of cataract surgeries performed worldwide, and large number of clinical trials performed, there is no consensus, neither established guidelines for the prevention and treatment of the postoperative ocular inflammation to date.”
From their results, the group noted the variability of management regimens, particularly, regarding the agents and drugs: “Some physicians used corticosteroids or NSAIDs alone, whereas others combined these two therapeutic classes.”
“Regarding the duration, some studies reported the prophylactic use of anti-inflammatory agents during a few weeks, whereas others reported in similar conditions the use of the same agents during two or three months,” Prof. Aptel added.
The study goes beyond the standard drops of corticosteroids and NSAIDs for postoperative inflammation, and includes a review of recent publications that highlights new molecules with new targets and novel delivery technique. Prof. Aptel adds that they reviewed, “new delivery systems that were recently reported, such as sustained release dexamethasone inserted in the canaliculus of the eyelid, in the anterior chamber or in the vitreous, and a biodegradable intrascleral betamethasone implant.”
So, were they able to find any sort of agreement or consensus? The review of the literature and the Delphi survey did lead the researchers to conclude that the same anti-inflammatory treatment could effectively be used to manage inflammation following cataract surgery and non-complicated pars plana vitrectomy for epiretinal membrane and macular hole. However, the work also highlighted the need for a more prolonged and more powerful treatment after glaucoma surgery.
Specifically related to vitreoretinal surgery, the study found discrepancies and lack of recommendations in both the preferred treatment and perception of the eye’s inflammatory status by experts for retinal detachment repair and for combined vitreoretinal/cataract surgeries. It was agreed that need certainly exists for trials to establish treatment guidelines.
Based on their findings, Prof. Aptel suggests that the solution to the inflammation puzzle may be: “Effective, safe and locally acting anti-inflammatory treatments of long-lasting duration administered by the surgeon immediately at the end of surgery could remove the need for patients to instil frequent eye drops and over a relatively long period of time, solve compliance uncertainty and limit side effects.”
Reference:
Aptel F, Colin C, Kaderli S, et al; OSIRIS group. Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey. Br J Ophthalmol. 2017; pii: bjophthalmol-2017-310324. [Epub ahead of print]
