Intravitreal dexamethasone implant versus systemic steroids as prophylaxis in uveitic cataract surgery: A randomized trial

Session Details

Session Title: Free Paper Session 10: Uveitis

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 11:18

Venue: Room 111

First Author: : A.Sudhalkar INDIA

Co Author(s): :    D. Bhojwani   A. Vasavada   V. Vasavada   S. Vasavada                    

Abstract Details

Purpose:

To determine the efficacy and safety of the intravitreal dexamethasone implant(IVD) when compared to systemic steroids(SS) as prophylaxis for patients with non-infectious intermediate, posterior or panuveitis and cataract undergoing cataract surgery.

Setting:

Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India

Methods:

Randomized controlled trial. Inclusion Criteria: Patients>18 years with non-infectious intermediate, posterior or panuveitis and cataract scheduled for cataract surgery. The uveitis had to be in remission for at least 3 months prior to scheduling for surgery. Exclusion Criteria: Glaucoma, steroid responders(if assigned to IVD), contraindications to SS(if assigned to SS), other ocular/systemic co-morbidities that may confound the result and intraoperative complications. Patients were randomly assigned to Group 1(IVD) or 2(SS). Preoperatively, a complete ocular and systemic exam, flare photometry FFA and OCT analysis was performed in all. Group 1 patients received IVD at the time of cataract surgery( standard phacoemulsification and IOL implantation). Group 2 patients were initiated on SS 1 week prior to surgery and tapered over 5 weeks postoperatively (1mg/kg body weight/day; max. 60 mg/day). An appropriate postoperative topical regimen was prescribed to all patients. Postoperatively, CDVA, IOP, flare photometry and OCT analysis (central subfield thickness) was performed on days 1, 7, 30 and then monthly upto 6 months. Primary Outcome measure was change in CDVA in both groups. Secondary outcome measure: Recurrence of uveitis, change in CST in both groups and complications, if any. Appropriate statistical analysis was done. Statistical significance was set at p<0.05

Results:

20 patients in Group 1(11 females) and 23 patients in Group 2(13 females) were recruited. The median age was 47.35 years(SD 4.2). The most common form of uveitis was intermediate uveitis(n=27). Five patients in Group 1 and 3 patients in Group 2 were type II diabetics. 2 patients in Group 1 and 1 patient in Group 2 were hypertensive. All patients underwent uneventful surgery. The CDVA in Group 1 improved from 0.48 logMAR(SD-0.1) to 0.1 logMAR(SD-0.04; p=0.03)at 1 month. Similarly, The CDVA in Group 2 improved from 0.56 logMAR (SD-0.06) to o.13 logMAR(SD-0.04). The difference between postoperative CDVA in both groups was insignificant (p=0.53). The improvement was maintained till the end of follow up. The OCT thickness remained unchanged in both groups till the end of follow up and the difference between groups was insignificant (p=0.13). Four patients in group 1 required IOP lowering topical therapy. 3 patients in Group 2 required insulin therapy while on steroids. No patient required stoppage of therapy /surgical intervention for adverse events. None of the patients had a recurrence of uveitis till the end of follow up. No other complications were noted.

Conclusions:

The intravitreal dexamethasone implant appears to be a viable alternative to systemic steroids as prophylaxis for patients with intermediate, posterior and panuveitis and uveitic cataract undergoing cataract surgery in an effort to curb recurrence of uveitis. None of the patients in either group developed sight/life threatening complications till the end of the follow up period and none of the patients in either group required a second intravitreal injection or a repeat course of systemic steroids. The IVD might especially be useful as prophylaxis in patients in whom SS are contraindicated.

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