Effect of NSAIDs on Pupil Diameter and Expression of Aqueous Humor Cytokines in FLACS Versus Conventional Phacoemulsification

Abstract

PURPOSE: To compare the concentrations of interleukin (IL) (IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and TNF-β in the aqueous humor of patients undergoing femtosecond laser–assisted cataract surgery (FLACS) and corneal mechanical paracentesis treated with two different topical nonsteroidal anti-inflammatory drugs (NSAIDs): bromfenac and indomethacin. METHODS: In this prospective, randomized controlled, single-center study, aqueous humor samples were obtained immediately after performing the femtosecond laser procedure or at the start of conventional phacoemulsification. Preoperatively, the FLACS groups were administered (once daily and four times daily, respectively) either topical bromfenac 0.09% (12 eyes) or indomethacin 0.1% (12 eyes). The corneal paracentesis bromfenac and indomethacin groups received the same regimen of instillation of NSAIDs, respectively. Quantitative analysis of the expressed cytokines in the aqueous humor was performed using FlowCytomix FC 500 Pro 3.0 Software (Bender MedSystems GmbH, Vienna, Austria). RESULTS: The intraoperative pupil diameter was correlated with the expression of IL-6 after the femtosecond laser procedure in the FLACS indomethacin group (r = −0.53; P = .07). A significant difference in mean pupillary size was detected between the FLACS bromfenac and indomethacin groups at the aspiration/irrigation time point (0.53 ± 0.26 mm) and at the end of surgery (0.68 ± 0.37 mm). Progressive pupillary constriction was observed in the indomethacin and bromfenac groups. CONCLUSIONS: A smaller expression of IL-6 to the overall cytokine network value was observed in cases receiving preoperative bromfenac 0.09%, explaining improved maintenance of intraoperative mydriasis. [ J Refract Surg. 2018;34(10):646–652.]

Subfoveal Choroidal Thickness After Femtosecond Laser-Assisted Cataract Surgery for Age-Related Cataracts

“…In a recent study, Liu et al found the lower aqueous malondialdehyde but higher prostaglandin E 2 and interleukin-1 receptor in the FLACS group compared with the conventional group ( 27 ). Also, evaluated interleukin-6 level was found in the FLACS group compared to controls ( 28 ). Nomura et al demonstrated that higher concentrations of CXCL13 were correlated with thicker subfoveal choroidal thicknesses in 76 eyes of cataract patients ( 29 ).…”

Efficacy of a hinged pupil expansion device in small pupil cataract surgery

“…There is no standard definition in the literature for what constitutes a small pupil. Most commonly pupil diameter less than 5 mm is considered as small[ 22 27 28 ]; however, there is a study that considered pupil diameter of 4 mm or less as small pupil. [ 6 ]…”

The benefits and drawbacks of femtosecond laser-assisted cataract surgery

“…In order to prevent intraoperative difficulties associated with a small pupil, non-steroidal anti-inflammatory drugs should be applied three to four times on the day prior to surgery, and in the morning before surgery. 70,73,74 In a study by Anisimova et al., 70 bromfenac 0.9% prevented the incidence of miosis better than indomethacin 0.1%. Walter et al.…”

“…67–69 Moreover, the magnitude of miosis is correlated with the concentration of intracameral interleukin-6. 70 Risk factors for intraoperative miosis during FLACS include longer laser pretreatment duration and older patient age. 71 Also other factors such as short pupil-capsulotomy distance, shallow anterior chamber, smaller pre-operative pupil size, and longer suction time are associated with intraoperative miosis.…”