Inflammation after cataract surgery

Currently, it is the only corticosteroid approved by the FDA for use in all inflammatory and allergy-related ophthalmic disorders, including inflammation after cataract surgery, uveitis, allergic conjunctivitis, and giant papillary conjunctivitis. Loteprednol etabonate resulted from a classic inactive metabolite-based soft drug approach (103-114). 

Ocular inflammation after cataract extraction Ophthalmic Instill 1 drop into the affected eye twice daily, beginning 24 hr after surgery and continuing for 2 wk. 

Although oral NSAIDs have application to ophthalmic pain management, topical NSAIDs have the more immediate utility. Some of the earliest indications for topical NSAIDs were prophylaxis and treatment for cystoid macular edema (CME) as well as pain and inflammation management after cataract surgery.This pioneering work ras done befiare the introduction of less traumatic procedures such as clear corneal incisions. The seminal investigations using... 

The topical NSAIDs as a group have demonstrated adjunctive efficacy in several clinical situations. These include synergistic activity with topical cortical steroids after cataract surgery. Amelioration of pain, inflammation, and resolution of CME after cataract surgery has been demonstrated. A similar effect on the mitigation of post-photorefractive keratectomy pain has also been shown. Ketorolac specifically has been suggested for concomitant application with cyclosporine A for the initial treatment of chronic dry eye disease. 

Diclofenac decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis. It is indicated in the treatment of rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Potassium salt is approved for management of mild to moderate pain and primary dysmenorrhea when prompt pain relief is needed. Ophthalmic used for treatment of postoperative inflammation after cataract removal temporary relief of pain and photophobia following corneal refractive surgery. Topical used for treatment of actinic keratosis. 

Corneal edema is a common finding postoperatively after uncomplicated, sutureless, scleral tunnel or clear corneal incision cataract surgery. More severe involvement (Figure 30-5) with persistent stromal edema, epithelial microcysts, and bullae may be found in patients with low endothelial cell counts, excessive inflammation from corneal trauma during the surgery, or an increased lOP secondary to retained lens material or inflammatory response. Bullae are typically secondary to increased corneal aqueous absorption due to high lOP or to a breakdown of the corneal endothelial aqueous pump. 

Belfort R Jr, Muccioli C. Hyphema after peribulbar anesthesia for cataract surgery in Fnchs heterochromic iridocyclitis. Ocul Immunol Inflamm 1998 6(l) 57-8. 

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