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Review
Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey
  1. Florent Aptel1,
  2. Cyrille Colin2,
  3. Sema Kaderli3,
  4. Catherine Deloche3,
  5. Alain M Bron4,
  6. Michael W Stewart5,
  7. Christophe Chiquet1
  8. on behalf of the OSIRIS group
    1. 1 Department of Ophthalmology, Joseph Fourier University, Grenoble, France
    2. 2 Pôle IMER, Hospices Civils de Lyon, Lyon, Rhône-Alpes, France
    3. 3 Solid Drug Development SA, Genève, Switzerland
    4. 4 Department of Ophthalmology, University Hospital, Dijon, France
    5. 5 Department of Ophthalmology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
    1. Correspondence to Dr Florent Aptel, Clinique Universitaire d’Ophtalmologie, CHU de Grenoble, 38043 Grenoble cedex 09, France; faptel{at}chu-grenoble.fr

    Abstract

    Prevention and management of postoperative ocular inflammation with corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been evaluated in several randomised controlled trials (RCTs). However, neither consensus regarding the efficacies of different regimens nor established guidelines are currently available. This has resulted in different practice patterns throughout the world. A systematic literature review found that for the management of postcataract inflammation nepafenac produced a positive outcome in three of three RCTs (3/3), as did ketorolac (1/1), bromfenac (7/7), loteprednol (3/3) and difluprednate (6/6), but not flurbiprofen (0/1). A single study found that betamethasone produced inconclusive results after retinal detachment (RD) surgery; ketorolac was effective (1/1) after vitrectomy, but triamcinolone was ineffective (0/1) after trabeculectomy. A two-round Delphi survey asked 28 international experts to rate both the inflammatory potential of different eye surgeries and their agreement with different treatment protocols. They rated trabeculectomy, RD surgery and combined phacovitrectomy as more inflammatory than cataract surgery. Vitrectomies for macular hole or epiretinal membrane were not deemed more inflammatory than cataract surgery. For trabeculectomy, they preferred to treat longer than for cataract surgery (NSAID + corticosteroid three times a day for 2 months vs 1 month). For vitrectomy alone, RD surgery and combined phacovitrectomy, the panel preferred the same treatment as for cataract surgery (NSAID + corticosteroid three times a day for 1 month). The discrepancy between preferred treatment and perception of the eye’s inflammatory status by the experts for RD and combined vitreoretinal surgeries highlights the need for RCTs to establish treatment guidelines.

    • Clinical Trial
    • Drugs
    • Glaucoma
    • Retina
    • Treatment Surgery

    https://doi.org/10.1136/bjophthalmol-2017-310324

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      Footnotes

      • Contributors FA (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), CyC (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), SK (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), CD (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), AMB (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), MWS (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work), ChC (conception of the work, acquisition of data, analysis of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work). Expert panel (OSIRIS Group): everyone listed met the ICMJE criteria for authorship. FA, Stephanie Baillif, Mariah Berrocal, Jean-Paul Berrod, AMB, ChC, François Devin, Marie-Noelle Delyfer, Philippe Denis, Marc D de Smet, Paolo Fogagnolo, David Gaucher, Philippe Germain, Agnès Glacet Bernard, Laurent Kodjikian, Antoine Labbé, Marc Labetoulle, Kaweh Mansouri, Carsten H Meyer, Timothy G Murray, Jonathan S Myers, Constantin J Pournaras, Frédéric Rouberol, Maher Saleh, Michael A Singer, MWS, Andrew J Tatham, Thomas Wolfensberger.

      • Funding This research was supported by Solid Drug Development SA (Geneva, Switzerland).

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Collaborators Expert panel (OSIRIS Group): everyone listed met the ICMJE criteria for authorship. FA, Stephanie Baillif, Mariah Berrocal, Jean-Paul Berrod, AMB, ChC, François Devin, Marie-Noelle Delyfer, Philippe Denis, Marc D de Smet, Paolo Fogagnolo, David Gaucher, Philippe Germain, Agnès Glacet Bernard, Laurent Kodjikian, Antoine Labbé, Marc Labetoulle, Kaweh Mansouri, Carsten H Meyer, Timothy G Murray, Jonathan S Myers, Constantin J Pournaras, Frédéric Rouberol, Maher Saleh, Michael A Singer, MWS, Andrew J Tatham, Thomas Wolfensberger.

      • Correction notice This article has been updated since it published Online First. The Collaborator group has been added.