H Schartner | PubMed Health

PubMed1997

[Minor effect of anti-inflammatory therapy on intraocular inflammation after minimally invasive phacoemulsification].

UNLABELLED: In a prospective study, we examined the influence of different anti-inflammatory treatments on intraocular inflammation after minimally invasive cataract surgery. PATIENTS AND METHODS: A total of 150 patients (39-88 years of age) underwent phacoemulsification using a temporal clear-corneal tunnel incision and implantation of a 5-mm PMMA posterior chamber. Each patient was randomly assigned to one of the following 5 treatment groups, each consisting of 30 patients: (1) diclofenac 0.1% unconserved eyedrops (DICun) pre- and postoperatively; (2) diclofenac 0.1% conserved eyedrops (DICco) pre- and postoperatively; (3) DICun postoperatively; (4) DICun pre- and postoperatively, plus dexamethasone-21-dihydrogenphosphate 0.1% eyedrops (DEXA) postoperatively; (5) DEXA postoperatively. The aqueous flare was measured pre- and postoperatively using the laser flare-cell meter. RESULTS: In group 1, the flare (in photon counts/ms) increased from 10.8 +/- 1.7 preoperatively to only 14.7 +/- 3.1 in the afternoon of the day of surgery. Even on day 1 postoperatively, the flare decreased to 9.3 +/- 0.9 and remained relatively constant on days 3 and 7 after surgery. There were no significant differences among the groups concerning flare means (P = 0.35) or time courses (P = 0.51). DISCUSSION: Anti-inflammatory treatment had no significant influence on the amount of postoperative aqueous flare. This is because of the fact that clear corneal phacoemulsification per se leads to an extremely low intraocular inflammation and thus makes the importance of anti-inflammatory pharmacotherapy relative.

Administration, Topical↗

PubMed1996

[Minimally inflammatory cataract surgery].

BACKGROUND: Cataract surgery leads to a more or less intensive postoperative inflammation due to breakdown of the blood-aqueous barrier. In a prospective, randomized and controlled clinical trial, we examined aqueous flare as well as intraocular pressure and visual acuity after a minimally invasive cataract surgical procedure under different anti-inflammatory treatment. PATIENTS AND METHOD: In 150 patients (39-88 years of age) without glaucoma or pre-existing deficiencies of the blood-aqueous barrier, phacoemulsification through a clear-corneal tunnel incision with implantation of a 5 mm PMMA posterior chamber intraocular lens was performed. Patients were randomly assigned to one of 5 treatment groups, each consisting of 30 patients: 1) preservative-free diclofenac 0.1% eyedrops (DICpf) pre- and postop.; 2) diclofenac 0.1% eyedrops with preservative (DICp) pre- and postop.; 3) DICpf only postop.; 4) DICpf pre- and postop. in combination with dexamethasone-21-dihydrogenphosphate 0.1% eyedrops (DEXA); 5) DEXA postoperatively. For prevention of postoperative intraocular pressure (IOP) elevation, carbachol 0.01% (for intraocular application) was injected into the anterior chamber intraoperatively, and dichlorphenamide (50 mg/d per os) was applied until day 1 postoperatively. - Aqueous flare (laser flare-cell meter FC-1000), IOP (Gold-mann applanation tonometer) and best-corrected visual acuity were determined on the day before surgery as well as 6 hrs (only flare and IOP), 1 day, 3 and 7 days postoperatively. RESULTS: Aqueous flare (photon counts/ms) in treatment group 1 increased from 10.8 +/- 1.7 (means +/- SE) preoperatively to only 14.7 +/- 3.1 in the afternoon of the day of surgery. Already on day 1 postoperatively, the flare decreased to 9.3 +/- 0.9, and remained relatively constant on days 3 and 7 after surgery. The flare in group 3 (DICpf only postop.) was significantly higher (p = 0.03; ANOVA) than in group 1. There were no other significant group differences concerning flare (group 1 vs. 3;1 vs. 4;4 vs. 5). -IOP (mm Hg) dropped from 16.3 +/- 0.2 preoperatively to 15.8 +/- 0.6 already 6 hrs postoperatively (group means). On days 1 and 3, the IOP continued to drop to 13.2 +/- 0.3 and 12.7 +/- 0.3, respectively. Not before day 7, the IOP tended to increase again (14.2 +/- 0.3). The IOP showed no significant group differences. - Visual acuity increased from 0.25 +/- 0.01 preoperatively to 0.73 +/- 0.02 already on day 1 postoperatively (group means). On days 3 and 7, the acuity amounted to 0.83 +/- 0.24 and 0.92 +/- 0.02, respectively. DISCUSSION: Under the conditions of the present study (with specific pharmacological therapy and patient selection), clear-corneal phacoemulsification leads to an extremely low and short-lasting intraocular inflammation, especially under pre- and postoperative treatment with preservative-free diclofenac eyedrops. Thus, the aim of minimally inflammatory cataract surgery (MICS) is realized. As secondary phenomenon, a postoperative IOP increase, often observed in the early postoperative period, is lacking, and the visual acuity rises very fast postoperatively.

Adult↗