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      Comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery

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          Abstract

          Purpose:

          To compare the results of intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification.

          Materials and Methods:

          Sixty eyes of 60 patients that underwent cataract surgery with phacoemulsification were randomized into two groups. Preoperative visual acuity of all patients was 0.5 or lower and intraocular pressures were under 21mmHg. After surgery, eyes in group 1 (30 eyes) were injected with 0.4 mg/0.1 ml dexamethasone into the anterior chamber, and eyes in group 2 (30 eyes) were injected with 2 mg/0.05 ml triamcinolone acetonide into the anterior chamber. All eyes received standard postoperative prednisolone acetate and moxifloxacin eye drops. The biomicroscopic evaluation, visual acuity, and intraocular pressure measurements were done at baseline (preoperatively) and on postoperative days 1, 7 and 30.

          Results:

          There were no statistically significant differences in mean visual acuity, the amount of anterior cells and flare between the two groups ( P ≥ 0.05). Mean intraocular pressure values at postoperative first day were significantly higher in group 2 than in group 1 ( P = 0.009). The mean intraocular pressures on days 7 and 30 after surgery were not statistically different between the two groups ( P ≥ 0.05).

          Conclusions:

          Intracameral dexamethasone and intracameral triamcinolone acetonide were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures on postoperative first day were higher in patients receiving intracameral triamcinolone acetonide. The highest intraocular pressure in triamcinolone acetonide group was 24 mmHg, and stabilized in a few days, therefore using triamcinolone acetonide may impose a minimal risk to patients. Nevertheless, intracameral dexamethasone seems to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 hours.

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          Most cited references22

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          Intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

          To report on intraocular pressure (IOP) after intravitreal injections of triamcinolone acetonide. Meta-analysis of previously reported data and case series studies. The study included 272 patients (305 eyes) receiving an intravitreal injection of approximately 20 mg triamcinolone acetonide as treatment for diffuse diabetic macular edema (n = 84 patients), exudative age-related macular degeneration (n = 181 patients), retinal vein occlusions (n = 20 patients), uveitis (n = 9), pseudophakic cystoid macular edema (n = 6), and other reasons (n = 5). Mean follow-up was 10.4+/-6.7 months (median, 7.9 months; range, 3.0-35.7 months). Intravitreal injection of approximately 20 mg triamcinolone acetonide. Intraocular pressure. Intraocular pressure readings higher than 21 mmHg, 30 mmHg, 35 mmHg, and 40 mmHg, respectively, were measured in 112 (41.2%) patients, 31 (11.4%) patients, 15 (5.5%) patients, and 5 (1.8%) patients, respectively. Triamcinolone-induced IOP elevation was treated by antiglaucoma medication in all but 3 (1.0%) eyes, for which filtering surgery was performed. Mean IOP started to rise 1 week after injection and returned to baseline values approximately 8 to 9 months after injection. Younger age (P = 0.029) was significantly associated with triamcinolone-induced ocular hypertension. Triamcinolone responders and triamcinolone nonresponders did not vary significantly in gender (P = 0.42), refractive error (P = 0.86), diabetes mellitus status (P = 0.74), and reason for treatment. These findings may be useful for comparing risks and benefits of intravitreal triamcinolone acetonide therapy.
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            Evaluation of the retinal toxicity and pharmacokinetics of dexamethasone after intravitreal injection.

            The intravitreal injection of steroids may be potentially useful in the treatment of endophthalmitis and other ocular inflammatory diseases. The retinal toxicity and intraocular turnover of aqueous solutions of dexamethasone sodium phosphate in doses ranging from 440 to 4000 micrograms were evaluated in the rabbit; evaluation was also performed for a 0.1-mL injection of a commercially available preparation (dexamethasone phosphate [Decadron] injection, 4 mg/mL). After the 440-micrograms dose, a transient increase in staining of the Müller cells was observed, which normalized after 2 days. Progressively higher doses resulted in an increasing spectrum of disorganization in Müller and other retinal cells. The half-life of the intravitreally injected drug was 3.48 hours. These findings suggest a primary interference in Müller cell function, possibly through dexamethasone-induced alterations in retinal glutamate or glucose metabolism.
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              • Article: not found

              Inflammation after sclerocorneal versus clear corneal tunnel phacoemulsification.

              To compare the postoperative inflammation after phacoemulsification followed by intraocular lens (IOL) implantation by means of sclerocorneal versus clear corneal tunnel incision. Randomized controlled clinical trial. One hundred eyes of 100 patients were examined at a German University eye hospital. One hundred eyes with cataract necessitating phacoemulsification with posterior chamber IOL implantation were randomly assigned to receive a temporal sclerocorneal or clear corneal tunnel incision by a single surgeon. Preoperative and postoperative inflammation was evaluated by measurement of flare using laser flare photometry. Statistical inference was mainly based on nonparametric group comparisons by use of two sample Wilcoxon tests. Mean anterior chamber flare in the group with sclerocorneal tunnel increased from 7.5 photon counts/ms preoperatively to 19.6 at 6 hours postoperatively and decreased to 11.1 (day 1), 11.7 (day 2), 11.6 (day 3), and 9.2 (5 months) during the postoperative course. The mean flare in the clear corneal tunnel incision group increased from 7.7 preoperatively to 12.9 at 6 hours postoperatively and then decreased to 9.2 (day 1), 9.8 (day 2), 9.1 (day 3), and 9.2 (5 months). Individual postoperative flare changes were significantly lower in the clear corneal tunnel group at the day of surgery (P<0.0001), as well as at day 1 (P = 0.0011), day 2 (P = 0.0079), and day 3 (P = 0.0020). After 5 months, no statistically significant difference was found. After phacoemulsification and foldable IOL implantation, postoperative alteration in the blood-aqueous barrier was statistically significantly lower with the clear corneal tunnel incision group compared with the sclerocorneal incision group, in the first 3 days postoperatively.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                August 2014
                : 62
                : 8
                : 861-864
                Affiliations
                [1]Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
                [1 ]Department of Health Care Management, Faculty of Medicine, Başkent University, Ankara, Turkey
                Author notes
                Correspondence to: Dr. Sirel Gür Güngör, Department of Ophthalmology, Faculty of Medicine, Baskent University, Fevzi Çakmak Caddesi, 06490, Bahçelievler, Ankara, Turkey. E-mail: sirelgur@ 123456yahoo.com
                Article
                IJO-62-861
                10.4103/0301-4738.141045
                4185164
                25230962
                f7761ab9-83bb-4c78-85ac-a481aa0ac653
                Copyright: © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 September 2013
                : 17 June 2014
                Categories
                Original Article

                Ophthalmology & Optometry
                dexamethasone,phacoemulsification,triamcinolone acetonide
                Ophthalmology & Optometry
                dexamethasone, phacoemulsification, triamcinolone acetonide

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