Cataract

Pr. Conceição Lobo

Coimbra, Portugal
University Hospital

Patient presentation:
?

This is a 76-year-old female with a nuclear senile

cataract on the left eye, with a best corrected visual
acuity of 2/10 and an IOP measurement of
16mmHg. The remaining biomicroscopic exam and
fundoscopy releaved no relevant alterations. She
was submitted to phacoemulsification and acrylic
IOL implantation. The pre-operative medication
included drop instillation of phenylephrine hydroch-
loride (10%), tropicamide (1%) and cyclopentolate
chlorhydrate (1%) for pupillary dilatation.
Cleansing the periocular region and ocular surface moderate corneal oedema and anterior-chamber
was made with povidone iodine (5%).The surgery flare = 2. The visual acuity was of 3/10. During the
was performed under topical anaesthesia using 1st week, the medication prescription was dexamet-
oxybuprocaine eye drops and no complication hasone 4 times per day, ofloxacine 5 times per day
occurred. and timolol maleate 2 times per day.
At week 1 visit, the visual acuity increased to 8/10
Treatment and follow up:
? and the biomicroscopic exam showed a resolution of
corneal oedema and inflammation in the anterior
Immediately after the surgery, 1 drop of dexametha- chamber. The use of dexamethasone drops was
sone phosphate 0.1% unpreserved and 1 drop of reduced to 3 times per day for one additional week.
ofloxacin were instilled into the lower conjunctival The ofloxacine and timolol maleate eye drops were
sac of the operated eye. The patient was instructed to stopped.
instil during the day; 3 drops of dexamethasone, 4 On day 14, after the surgery, the best corrected
drops of ofloxacine and 2 drops of timolol maleate visual acuity was of 10/10 and the biomicroscopic
0.5%. exam was normal. During all the treatment period
On day one, after the surgery, the biomicroscopic the patient did not have subjective discomfort or any
exam showed a discrete conjunctival hyperaemia, a other symptoms related to the medication.
Conclusion
? References:
After cataract extraction, the eventual breakdown of
aqueous-blood barrier is responsible for inflamma-
tory response mediator release. The steroids inter-
fere with the inflammatory response by inhibition of
arachidonic acid, the first step of the inflammatory
process. The course of ocular inflammation evalu-
ated showed that the peak is on the first day needing
dosage of topical treatment.
Dexamethasone eye drops without preservatives is
an option for medication after cataract surgery,
since it combines the rapid efficacy in resolving post-
surgery inflammation with the reduction of discom-
fort symptoms and ocular irritation often related to
the medication preservatives.
1. Sanders DR, Kraff M. Steroidal and nonsteroidal anti-
inflammatory agents. Effect on postsurgical inflammation and
blood-aqueous humor barrier breakdown. Arch Ophthalmol.
1984; 102: 1453-6.
2. Miyake K, Masuda K, Shirato S, Oshika T, Eguchi K, Hoshi H,
Majima Y, Kimura W, Hayashi F. Comparison of diclofenac and
fluorometholone in preventing cystoid macular edema after
small incision cataract surgery: a multicentered prospective
trial. Jpn J Ophthalmol 2000; 44: 58-67.
3. Guex-Crosier Y. [Non-steroidal anti-inflammatory drugs and
ocular inflammation] .Klin Monatsbl Augenheilkd 2001; 218:
305-8.
4. Laurell CG, Zetterström C. Effects of dexamethasone, diclofe-
nac, or placebo on the inflammatory response after cataract
surgery. Br J Ophthalmol 2002; 86: 1380-4.
5. Labbé A, Pauly A, Liang H, Brignole-Baudouin F, Martin C,
Warnet JM, Baudouin C. Comparison of toxicological profiles
of benzalkonium chloride and polyquaternium-1: an experi-
mental study. J Ocul Pharmacol Ther 2006; 22: 267-78.