Eyeworld

16 | EYEWORLD | JULY 2021 ASCRS NEWS Contact Santos: mcsantos@wustl.edu Sheybani: sheybaniar@wustl.edu Conclusion Erichsen et al. provided evidence that NSAID monotherapy may be an adequate treatment regimen for early postoperative inflammation following cataract surgery, with no statistically significant benefit from the addition of topical steroids. Dropless cataract surgery with subten- on dexamethasone was ineffective in controlling early postoperative inflammation. We look for- ward to future data from Erichsen et al. to see more long-term outcomes from this randomized controlled trial. this trend existed in Erichsen et al.'s study, this did not reach the level of statistical significance. The ASCRS Journal Club discussion also suggested that dexamethasone may not be the best choice for dropless cataract surgery given its brief duration. Triamcinolone may last longer than the 24–48 hours expected with dexamethasone. Intracanalicular or intracam- eral delivery devices of steroid medication may be more promising dropless options. While dropless cataract surgery may be a good goal, some panelists suggested "less drops" might be reasonable as well, using intracameral antibi- otics in lieu of topicals, prednisolone acetate in the early postoperative period, and using a once daily NSAID for a longer duration to help prevent CME. Effect of anti-inflammatory regimen on early postoperative inflammation after cataract surgery Jesper Erichsen MD, Julie Forman, MSc, PhD, Lars Holm MD, PhD, Line Kessel, MD, PhD J Cataract Refract Surg. 2021;47(3):323–330. n Purpose: To investigate if a combination of topical nonsteroid anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a subtenon depot of steroid was placed during surgery. n Setting: Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark. n Design: Prospective randomized controlled trial with masked statistical analyses. n Methods: Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eye drops combined (groups Pred+NSAID-Pre [control group] and Pred+NSAID-Post) vs. ketorolac monotherapy (groups NSAID-Pre and NSAID-Post) vs. subtenon depot of dexamethasone (Dropless group). Drops were used until 3 weeks postoperatively, starting 3 days before surgery in the "Pre" groups and on the day of surgery in the "Post" groups. Aqueous flare was measured at baseline and 3 days postoperatively. n Results: 456 participants, mean age 72.1 (SD 7.0) years, 283 (62%) females, were included. Flare increased significantly more in the Dropless group compared with control (Pred+NSAID-Pre), but none of the other groups differed significantly from the control. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eye drops (Pred+NSAID-Pre and Pred+NSAID-Post) compared with NSAID monotherapy and Dropless. No differences in postoperative visual acuity were found compared with control. n Conclusion: No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery, but subtenon depot of dexamethasone was less efficient. Initiating prophylactic eye drops prior to surgery did not influence early postoperative anterior chamber inflammation. continued from page 15

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