1. Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey
- Author
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Aptel, Florent, Colin, Cyrille, Kaderli, Sema, Deloche, Catherine, Bron, Alain, Stewart, Michael W., Chiquet, Christophe, on behalf of the OSIRIS group, ., Université Joseph Fourier - Grenoble 1 (UJF), Hospices Civils de Lyon (HCL), Solid Drug Development SA, Partenaires INRAE, Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Service d’Ophtalmologie, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), and Mayo Clinic School Medicine
- Subjects
medicine.medical_specialty ,Triamcinolone acetonide ,Delphi Technique ,medicine.medical_treatment ,Vitrectomy ,Cataract Extraction ,Ophthalmologic Surgical Procedures ,triamcinolone acetonide ,Nepafenac ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Postoperative Complications ,0302 clinical medicine ,drug-delivery system ,Surveys and Questionnaires ,Ophthalmology ,medicine ,Humans ,Trabeculectomy ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,Glucocorticoids ,Inflammation ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Disease Management ,chamber ,Cataract surgery ,lens implantation ,vitreoretinal surgery ,Sensory Systems ,health-care services ,3. Good health ,Surgery ,Ketorolac ,randomized clinical-trial ,rhegmatogenous retinal-detachment ,loteprednol etabonate ,Loteprednol ,030221 ophthalmology & optometry ,Bromfenac ,business ,ophthalmic solution ,030217 neurology & neurosurgery ,cystoid macular edema ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,medicine.drug - Abstract
Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye's inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines.
- Published
- 2017