Postoperative inflammation

Ocular surgery For treatment of postoperative inflammation following ocular surgery. 

Postoperative inflammation Apply 1 to 2 drops into the conjunctival sac of the operated eye(s) 4 times daily beginning 24 hours after surgery and continuing throughout the first 2 weeks of the postoperative period. MEDRYSONE Shake well before using. Instill 1 drop into the conjunctival sac up to every 4 hours. 

Apart from their anti-inflammatory activity the NSAIDs also show, dependent on the condition and the type of pain, considerable analgesic efficacy. In some forms of postoperative pain the NSAID s can be as efficacious as opioids, especially when prostaglandins, bradykinin and histamine, which are released by inflammation, have caused sensitization of pain receptors to normally painless stimuli. In Table 4 some advantages and disadvantages of NSAID s and opioids are compared. Although analgesic effects at peripheral or central neurons cannot be excluded completely, most studies indicate that... 

Also used in posttraumatic and postoperative pain, inflammation and swelling e.g. following dental or orthopaedic surgery, painful and/or inflammatory conditions in gynaecology e.g. primary dysmenorrhoea or adnexitis, in severe painful inflammatory infections of the ear, nose or throat e.g. pharyngotonsillitis, otitis etc. 

A 0.1% ophthalmic preparation is recommended for prevention of postoperative ophthalmic inflammation and can be used after intraocular lens implantation and strabismus surgery. A topical gel containing 3% diclofenac is effective for solar keratoses. Diclofenac in rectal suppository form can be considered for preemptive analgesia and postoperative nausea. In Europe, diclofenac is also available as an oral mouthwash and for intramuscular administration. 

Clinical use Flurbiprofen is a nonsteroidal antiinflammatory drug used for the treatment of pain and inflammation associated with musculoskeletal and joint disorders as well as neuralgias, dysmenorrhoea and postoperative pain. 

Clinical use Niflumic acid (Auclair et al., 1989) is a nonsteroidal anti-inflammatory drug used for the treatment of inflammation and pain in musculoskeletal and joint disorders such as rheumatoid arthritis as well as traumatic and postoperative pain. Niflumic acid is used in oral, rectal or topical preparations (up to 750 mg/day). 

The Loteprednol Etabonate Postoperative Inflammation Study Group 2, A double-masked, placebo-controlled evaluation of 0.5% loteprednol etabonate in the treatment of postoperative inflammation, Ophthalmology 705 1780 (1998). 

Satoskar, R.R., Shah, S.J. and Shenoy, S.G. (1986) Evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. International Journal of Clinical Pharmacology and Theoretical Toxiclogy 24, 651-654. 

Like fluorometholone, rimexolone lacks a hydroxyl group in the 21 position. Available as a 1% ophthalmic suspension (Vexol) (see Table 12-4), it has FDA approral for treatment of uveitis and postoperative inflammation. 

Steroid-indnced calcinm deposits in the cornea have been reported. Patients with such persistent epithelial defects snch as postoperative inflammation, penetrating keratoplasty, and a history of herpetic keratitis and dry eye have developed a calcific band keratopathy after topical nse of a steroid phosphate formnlation. 

Primary eye care providers may collaborate with ophthalmic surgeons to comanage the cataract patient. This method of eye care delivery provides quality care for the patient in convenient familiar surroundings. In addition, it is efficient and cost-effective. The goals of the comanagement team during postoperative care are those of everyday optometric practice to educate and reassure the patient, to prevent infection, to control inflammation, to maintain desired intraocular pressure (lOP), to manage complications if they arise, to control pain, and to optimize vision. 

A variety of studies suggest that several of the currently available NSAIDs are effective in reducing postoperative anterior segment inflammation and early angiographic and clinically significant pseudophakic CME. Therefore topical NSAIDS may be used for this purpose pre- and postoperatively, especially for patients at higher risk for postoperative inflammation. 

The most efficient topical medications to reduce lOP in postoperative patients are those whose mechanism involves aqueous suppression. These agents would include topical carbonic anhydrase inhibitors, apracloni-dine, brimonidine, beta-blockers, and oral carbonic anhydrase inhibitors. Prostaglandin analogues and miotics are effective in lowering the lOP postoperatively however, they may cause increased inflammation and should not be considered a first-line treatment. 

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. 

In patients with history of ocular inflammation, 1% prednisolone acetate, one drop four times a day for 3 to 7 days, can be prescribed prophylactically after Nd YAG. Rarely, a patient without history of inflammation may present with flare or mild cells in the anterior chamber or CME after capsulotomy. This also should be treated with topical steroids in the same manner. Post-YAG elevated lOP can often be prevented by treating the eye with apra-clonidine (lopidine) or other aqueous suppressant topical medication. The recommended dosage is one drop applied before the capsulotomy and one drop immediately after the procedure. Because of the potential risk of a retinal break, patients should receive dilated fundus examinations postoperatively as part of the routine follow-up within 1 to 4 weeks of capsulotomy, or sooner if symptoms develop. 

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