A STEP FORWARD

A dual topical medication regimen including an NSAID started preoperatively and continued after surgery with a corticosteroid is better than using the corticosteroid alone suggest the results of a recent randomised, double-masked, placebo-controlled trial. The study was undertaken by cataract surgeons at Sahlgrenska University Hospital, Molndal, Sweden and St Erik’s Eye Hospital, Stockholm, Sweden, and was presented by Anna Zaczek MD, PhD, at the XXXI Congress of the ESCRS in Amsterdam. It included 152 eyes of 152 patients selected for having uncomplicated cataract surgery and no other ocular disease.

All patients were treated postoperatively with dexamethasone 0.1 per cent suspension three times daily for three weeks, but they were randomised to receive nepafenac 0.1 per cent ophthalmic suspension (Nevanac, Alcon) or artificial tears three times daily, starting two days before surgery and continued for three weeks postoperatively. "Postoperative BCVA was excellent in both treatment groups with no statistically significant differences found between groups at three and six weeks after surgery," Dr Zaczek said.

“Combination treatment had benefits for reducing postoperative ocular pain and discomfort, macular swelling and anterior chamber inflammation. These results may be considered to offer one step forward to finding the optimal medication regimen for cataract surgery,” she added.

Laser flare

Higher anterior chamber inflammation in the control eyes was observed by laser flare meter readings on the first postoperative day. Macular swelling was measured by OCT and the results showed a significantly greater increase in total macular volume at both three and six weeks in the control eyes versus those receiving combination treatment.

Changes in macular thickness from baseline to six weeks at each of nine measured areas were also analysed to determine the proportion of eyes with a thickness increase > 10 microns. This level of swelling in the central macula occurred at a significantly lower rate in the combination group compared with controls (40 per cent vs. 60 per cent) at six weeks. There were also statistically significant differences favouring the combination group at each of the other eight sites, with the difference in rates consistently ranging between 20 per cent and 24 per cent.

“These macular changes were subclinical overall as mean BCVA was better than 20/20 in both groups at three and six weeks. However, at three weeks, there was one case of clinically significant CME and one case of subclinical CME diagnosed by OCT, both in the control group,” Dr Zaczek said.

More combination-treated patients compared with controls reported being pain-free during surgery, although the difference was not statistically significant. However, there was a statistically significant difference favouring the combination group over the controls in the proportion of patients pain-free on postoperative day one (59 per cent vs. 22 per cent) (see figure above) as well as in the proportion free of ocular discomfort at day one (80 per cent vs. 55 per cent) and three weeks (95 per cent vs. 83 per cent).

At three weeks, eyes in the combination group were more likely than the controls to have mild to moderate punctate corneal epithelial defects (27 per cent vs. 10 per cent). No eye had severe epithelial defects.