Managing Inflammation After Cataract Surgery – Episode 55

As the optometric profession continues to evolve, so does our involvement in co-managing surgical patients. This is no more true than when managing patients postoperatively after cataract surgery. As can be seen here, a certain amount of inflammation is expected to be seen in the eye postoperatively. This is a patient that is one day post-op. Now, traditionally we’ve controlled postoperative inflammation by providing patients with topical medications. Corticosteroids provide significant reduction in inflammation. Antibiotics protect against the pathogens that may cause postoperative infections and non-steroidal anti-inflammatory agents not only help with inflammation but also help modulate pain. Recently, there’s been significantly more discussion around dropless cataract surgery. A good friend and colleague Dr. Justin Schweitzer recently published an article on this in Advanced Ocular Care. In the article, he discusses the clinical rationale along with the evidence to support a dropless post-opt regimen. Two formulas are commonly used. Trimox is a combination of moxifloxacin and the steroid triamcinolone. Tri-Moxi-Vanc is a combination of moxifloxacin, triamcinolone, and vancomycin. Each of these formulations are injected directly behind the IOL, through the zonules, and into the vitreous cavity. The patient’s vision may be blurry in the first 48 hours after it’s injected. The patient may also note the appearance of floaters or a dark shadow immediately after the injection and up to 72 hours postoperatively. There’s also a small chance of Tri-Moxi-Vanc injection can pass through the pupil and settle into the anterior chamber giving the appearance of a hypopyon, a sign of endophthalmitis. with a key difference being an eye with endophthalmitis will be red and painful. Now, inflammation is a necessary evil with intraocular surgery. Fortunately, there are effective ways to control the inflammatory response. It’s important to have appropriate expectations post-operatively and also appreciate new advancements in drug delivery to optimize patient outcomes. By keeping these things in mind it’ll help us appropriately care for our patients, which is ultimately why we do what we do.

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