Intraoperative dexamethasone implant combined with phaco effective in uveitis patients

This prospective, randomized study found that combining intraoperative dexamethasone implant insertion with phacoemulsification and IOL implantation in uveitis patients with cataract appears to be a safe and effective alternative to systemic corticosteroid prophylaxis.

Since the main problem in cataract surgery on uveitic patients is the exacerbation of inflammation after surgery, topical and systemic corticosteroids are routinely used in the perioperative period to control inflammation. While systemic corticosteroids have been used for control, as well as prophylaxis, of inflammation, these drugs can have serious systemic and local side effects with prolonged usage.

An intravitreal implant containing 700 µg dexamethasone (Ozurdex) has been approved by the FDA for the treatment of macular edema in retinal vein occlusions. This implant has shown promising results in cases of macular edema in posterior uveitis and persistent diabetic macular edema, with significant improvement in visual acuity.

The current study included 20 patients with uveitis and cataract who underwent phacoemulsification with IOL implantation. Ten patients received an intravitreal dexamethasone implant intraoperatively, and 10 patients received oral steroids.

The logMar BCVA improved from 0.93 ± 0.49 to 0.23 ± 0.23 in the implant group and from 1.29 ± 0.47 to 0.22 ± 0.16 in the steroid group. Ninety percent of patients in the implant group and 80 percent of patients in the steroid group achieved logMar visual acuity of 0.3 (6/12) or better at the six-month visit.

Postoperative IOP and central macular thickness showed no statistically significant differences between the two groups. In the implant group, there was excellent postoperative inflammation control over an extended period, with decreased need for supplementary anti-inflammatory medications. None of the patients in either group had a significant IOP rise requiring surgical intervention.

Ozurdex should be injected before starting phacoemulsification, which occurred in the present study. The idea is to avoid pressure in the eye that would occur if the implant was inserted after surgery.

The authors conclude that a single intraoperative intravitreal dexamethasone implant during phacoemulsification in uveitis patients with cataract seems to be an effective alternative to postoperative oral steroids.