Vitreous Injection New Option for Postoperative Cataract Care

Jennifer Garcia

July 28, 2016

In an effort to overcome issues with noncompliance, a new study evaluated the efficacy of transzonular vitreous injection compared with standard topical therapy after cataract surgery and found outcomes between the two methods to be similar. These study findings were published online July 18 in Clinical Ophthalmology.

"The results in the current study suggest that patients receiving the combination drops in one eye and a one-time intraocular injection in the other eye had similar satisfaction and outcomes, though more patients preferred the injection to the drops," write Bret L. Fisher, MD, from the Eye Center of North Florida, Panama City, and colleagues.

The study authors enrolled 25 patients (average age, 69 years) presenting for uncomplicated bilateral cataract surgery or refractive lens exchange surgery with intraocular lens implantation. Surgery in each eye was scheduled 1 to 2 weeks apart. After the first eye surgery, all patients were randomly assigned to receive either a single transzonular vitreous injection of triamcinolone, moxifloxacin, and vancomycin or a standard topical regimen using a combination formulation. The topical single-drop formulation consisted of prednisolone, moxifloxacin, and ketorolac three times daily for 1 week, followed by a topical prednisolone and ketorolac formulation twice daily for 2 to 4 weeks. The opposite protocol was used after the second eye surgery.

Patients were evaluated at 1 day, 1 week, and 1 month postoperatively for each eye, and changes from baseline for intraocular pressure, as well as changes in corneal and macular thickness, were assessed. Patients were also asked to evaluate pain perception, visual quality, and overall satisfaction with surgery.

Changes in intraocular pressure were similar between the groups (P = .81), and there was no statistically significant difference in intraocular pressure over time (P = .74). In addition, the authors found no statistically significant difference in central macular thickness or central corneal thickness between the groups (P = .18 and P = .92, respectively), as well as no difference in reported pain (P = .67). Five patients reported rebound inflammation: three in the injection group and two in the topical group (P = .68).

Overall, 22 (92%) of 24 patients preferred the injection and 21 (88%) of 24 patients felt the injection provided a superior visual outcome.

A single surgeon performed all surgeries and injections, and the study excluded patients with intraoperative complications. Cataract grade was similar between the groups.

The authors acknowledge that a larger sample size would have been helpful, but note that "this is the first study to compare the combination of both anti-infective and anti-inflammatory drugs using transzonular injection and topical delivery methods for the purpose of cataract surgery prophylaxis."

Further, the authors suggest that greater convenience with comparable efficacy may have been a factor in why more patients preferred injection over standard topical therapy.

Funding for the study was provided by Imprimis Pharmaceuticals. The authors have disclosed no relevant financial relationships.

Clin Ophthalmol. 2016;10;1297-1303. Full text

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