J Korean Ophthalmol Soc.  2015 May;56(5):721-726. 10.3341/jkos.2015.56.5.721.

Intravitreal Injection of Dexamethasone Implant during Cataract Surgery in Patients with Noninfectious Uveitis

• Kim DH
• Cho BJ
• Chung H
• Heo JW

• KMID: 2121170
• DOI: http://doi.org/10.3341/jkos.2015.56.5.721

Abstract

PURPOSE
To investigate the efficacy and safety of intravitreal dexamethasone implant for controlling postoperative inflammation among uveitis patients undergoing cataract extraction.
METHODS
Ten eyes with noninfectious uveitis underwent phacoemulsification with intraocular lens implantation followed by intravitreal injection of 0.7-mg dexamethasone implant (implant group) between February 2011 and January 2014. Twenty age- and gender-matched controls who received cataract surgery without implantation during the same period were recruited (non-implant group). Medical records of the subjects were retrospectively reviewed and 6-month postoperative clinical outcomes were compared between the 2 groups.
RESULTS
The mean age was 42.30 +/- 15.81 years in the implant group and 45.65 +/- 13.63 years in the non-implant group. The 2 groups were similar in terms of age, gender, preoperative inflammatory status, and preoperative visual acuity (p = 0.552, 1.000, 0.133 and 0.767, respectively). After surgery, oral steroid was used in the non-implant group (8.8 +/- 1.5 mg/day on average) and the implant group (3.5 +/- 1.3 mg/day; p = 0.029). Visual acuity (log MAR) improved significantly in both groups (p = 0.789) with no significant difference between the 2 groups. Postoperative recurrence rates of uveitis were reduced more (40%) in the implant group than in the non-implant group (50%) but without significance (p = 0.709). Elevated intraocular pressure > or =25 mm Hg occurred in 3 eyes (30%) in the implant group and 4 eyes (20%) in the non-implant group (p = 0.657), of which 1 in each group required a filtering surgery. Otherwise, no significant complications developed in either group.
CONCLUSIONS
Intravitreal dexamethasone implants help reduce conventional oral steroid dosage for controlling postoperative inflammation. Dexamethasone implants could be an effective and safe alternative to control the inflammation after cataract surgery in uveitis patients.

Keyword

Cataract surgery; Intravitreal dexamethasone implant; Uveitis

MeSH Terms

Cataract Extraction
Cataract*
Dexamethasone*
Filtering Surgery
Humans
Inflammation
Intraocular Pressure
Intravitreal Injections*
Lens Implantation, Intraocular
Medical Records
Phacoemulsification
Recurrence
Retrospective Studies
Surgery, Oral
Uveitis*
Visual Acuity
Dexamethasone

Figure

• 

  Figure 1. Uveitis activity presented as anterior chamber cell grade before and after cataract surgery between 0.7 mg dex-amehasone implant and non-implant group. No significant differences are found at all points. A/C = anterior chamber; DEX = dexamethasone; POD = postoperative day.

• 

  Figure 2. Systemic steroid dose before and after cataract surgery with independent-samples t-test. (A) Preoperative dose. (B) Postoperative dose. No significant differences are found before surgery ( p = 0.136). Significant differences are found after surgery ( p = 0.029).

• 

  Figure 3. Consecutive changes of visual acuities (log MAR) after cataract surgery in patients with noninfectious uveitis. Visual acuities were improved significantly with Bonferroni correction in both groups. POD =postoperative day; DEX = dexamethasone. * p < 0.05 compared to baseline visual acuity of DEX-implant group; †p < 0.05 compared to baseline visual acuity of Non-implant group.

Reference

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