Evaluation of whether intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery

Mataftsi, Asimina; Dabbagh, Ahmad; Moore, Will; Nischal, Ken K.

doi:10.1016/j.jcrs.2012.05.034

Cited by 20 publications

(9 citation statements)

References 19 publications

(25 reference statements)

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“…Currently, comparative studies of anti-inflammatory drugs for control of post cataract surgery AC inflammation have been proposed in clinic (21)(22)(23). Previous study has evaluated the efficacy of intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery (24). In addition, clinical study has presented the tolerance and efficacy of piroxicam used in cataract surgery, compared with diclofenac and indomethacin (25).…”

Section: Discussionmentioning

confidence: 99%

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

et al. 2017

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Abstract. The aim of the present study is to determine the efficacy of dexamethasone (DEX) vs. indomethacin (IND) and ciprofloxacin (CIP) in modulating immediate inflammation following cataract surgery. A total of 644 patients with cataract were recruited and inflammation was investigated during the perioperative period. The management protocol was similar in both groups. Each drug was given four times a day for 30 days starting 7 days prior to surgery. The primary efficacy criteria for evaluation were the reduction in anterior chamber (AC) flare and AC inflammation score, in addition, a different secondary efficacy and safety evaluation criteria were maintained. The results demonstrated that the average inflammation score was 1.2±0.8 in the DEX group, which was significantly lower compared with the IND (1.9±0.7) and CIP (1.8±0.6) groups. Intra-ocular pressure was decreased following treatment with DEX, while intra-ocular pressure was slightly increased in the IND (1.9±0.7) and CIP (1.8±0.6) groups. The final visual outcomes for patients postcataract surgery were clinically superior in the DEX group compared with that of the IND and CIP groups (P=0.034 and P=0.042, respectively), but there was no significant difference between the ND and CIP groups (P= 0.78). Outcomes indicated that AC inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia, and tearing were significantly improved in each group. No significant poor local tolerance or adverse reaction was observed in the DEX, IND and CIP groups. In conclusion, the outcomes of the present study suggest that DEX serves an important role in the clinical pharmaceutical treatment of patients with cataract surgery.

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Section: Discussionmentioning

confidence: 99%

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

et al. 2017

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“…Mataftsi and colleagues looked at 18 patients with a median age of 3 months at cataract removal and a median follow-up of 38 months. Four of the studied eyes require temporary IOP-lowering medication, but none of the eyes developed glaucoma during the study period [34].…”

Section: Complications Of Intraocular Steroid Therapymentioning

confidence: 92%

Treatment of diabetic macular edema with sustained-release glucocorticoids: intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant

Ciulla

Harris

McIntyre

et al. 2014

Expert Opinion on Pharmacotherapy

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The intravitreal route of administration minimizes systemic side effects of glucocorticoids. Furthermore, sustained-release low-dose delivery via the DEX implant or the FA implant will limit frequent intravitreal injection and possibly some cost associated with intravitreal anti-VEGF therapy. In addition, the durable action of these treatments facilitates combination therapy. Patients can receive these implants as foundational therapy, and then receive additional treatment with laser or intravitreal anti-VEGF agents as combination therapy, which may conceivably provide some synergistic benefit. While the FA implant lasts much longer than the DEX implant, potentially decreasing the visit and treatment burden on patients and their families, the FA implant appears to have a greater risk of inducing ocular hypertension and cataract. However, these modalities have not been directly compared in a clinical trial and there is insufficient evidence to draw more elaborate conclusions.

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“…Postoperatively, subconjunctival or intracameral steroids are recommended to suppress inflammation in the immediate postoperative period. 135 , 136 Intracameral recombinant tissue-plasminogen activator has also been shown to reduce the fibrinous reaction and pigment deposits on the IOL after pediatric cataract surgery, though there is a risk of hyphema. 124 Decrease in the rates of postoperative endophthalmitis in adults has been reported with the intracameral use of antibiotics.…”

Section: Posterior-capsule Managementmentioning

confidence: 99%

Pediatric cataract: challenges and future directions

Medsinge

Nischal²

2015

OPTH

Self Cite

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Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.

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Evaluation of whether intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery

Abstract: Intracameral preservative-free dexamethasone in infantile cataract surgery did not seem to cause an increased risk for glaucoma and appeared to protect against anterior membrane formation.

Cited by 20 publications

References 19 publications

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

Treatment of diabetic macular edema with sustained-release glucocorticoids: intravitreal triamcinolone acetonide, dexamethasone implant, and fluocinolone acetonide implant

Pediatric cataract: challenges and future directions

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