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Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey
- Source :
- British Journal of Ophthalmology, British Journal of Ophthalmology, BMJ Publishing Group, 2017, 101 (11), pp.1-10. ⟨10.1136/bjophthalmol-2017-310324⟩, British Journal of Ophthalmology, 101(11), 1-10
- Publication Year :
- 2017
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 00071161 and 14682079
- Database :
- OpenAIRE
- Journal :
- British Journal of Ophthalmology, British Journal of Ophthalmology, BMJ Publishing Group, 2017, 101 (11), pp.1-10. ⟨10.1136/bjophthalmol-2017-310324⟩, British Journal of Ophthalmology, 101(11), 1-10
- Accession number :
- edsair.doi.dedup.....6557662fc27edee8dfeb81b04859e24f