Intravitreal Placement of Antibiotic/Steroid as Substitute for Postoperative Drops After Cataract Surgery
Narrative Responses:
Purpose
To determine the effectiveness of intravitreal antibiotic/steroid (Trimoxi) injection during phacoemulsification with IOL in preventing postoperative inflammation, cystoid macular edema, and endophthalmitis.
Methods
1575 consecutive eyes undergoing uncomplicated phacoemulsification with IOL surgery were given an intravitreal injection of 0.2 cc preservative free triamcinolone/moxifloxacin 15mg/1mg/ml. These injections were administered with a 27 gauge cannula passed through the zonules via the ciliary sulcus inferiorly at the termination of the procedure following IOL implantation and prior to aspiration of the viscoelastic. No antibiotic or steroid drops were administered postoperatively, however a topical NSAID was used in 22% of cases who either received a premium IOL or were deemed at higher CME risk due to ERM or diabetes. Patients were examined on the day of surgery and at 3 weeks postoperatively. Medical records were retrospectively reviewed for the incidence of inflammation, clinical CME, and endophthalmitis.
Results
Mean patient age was 73. Patients were followed for a minimum of 3 months postoperatively. Same day IOP (4-7 hours post-op) was minimally elevated with a mean of 22 mm Hg. At 3 weeks postoperatively, IOP was normal in most subjects with a mean of 15 mm Hg with no patients requiring the addition of ocular hypotensives. At 3 weeks postoperatively uncorrected acuity was 20/40 or better in 78% with best corrected acuity 20/40 or better in 96% and 20/25 or better in 79%. Two and a half percent developed mild iritis requiring the addition of topical steroids in the postoperative period. The overall incidence of CME in the data set was 2%. There were no cases of endophthalmitis or steroid responders.
Conclusion
Intraoperative placement of triamcinolone/moxifloxacin in the anterior vitreous at the time of phacoemulsification was found to be effective in the prevention of inflammation, endophthalmitis, and cystoid macular edema.