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Pre- and postoperative treatment with the potent corticosteroid difluprednate ophthalmic solution 0.05% significantly improves outcomes after cataract surgery compared with use of prednisolone acetate ophthalmic suspension 1% and so results in patient satisfaction.
Dr. Donnenfeld presented the results from a prospective, multicenter, observer-masked study he conducted with Edward Holland, MD, and Kerry Solomon, MD. The trial randomly assigned 39 patients undergoing bilateral cataract surgery to use of difluprednate in one eye and prednisolone acetate contralaterally.
The second eye was operated on after a 2-week interval, and all surgeries were uncomplicated. The corticosteroids were administered in a pulsed regimen perioperatively (10 doses) and then with a 2-week tapering course postoperatively.
"Despite advances in cataract surgery technique and technology, we have been disappointed that many patients still have cloudy corneas or even mild corneal thickening postoperatively that decreases their quality of vision," said Dr. Donnenfeld, founding partner, Ophthalmic Consultants of Long Island and Connecticut, and clinical professor of ophthalmology, New York University, New York. "Results of our controlled study document that use of difluprednate addresses this issue and improves the postoperative results in statistically and clinically significant ways.
"I have been using difluprednate in all of my cataract surgery patients for [more than] a year," he added. "My patients are much happier because of the 'wow' effect on their vision and are more likely to spread the word to everyone they know about their positive experience."
Several lines of evidence led Dr. Donnenfeld and colleagues to consider the pulsed difluprednate regimen as a solution to achieving improved outcomes after cataract surgery. Recognizing that high-dose corticosteroids are used in neurology and neurosurgery to reduce post-traumatic neuronal degeneration, improve neuronal function, and prevent neuronal cell death after spinal cord injury, they reasoned that because the corneal endothelium is also of neuroectodermal origin, a similar regimen might be beneficial for corneal protection in cataract surgery.
"I have found difluprednate to be the steroid of choice for all complicated cataract [procedures]," said Dr. Holland, director of cornea services, Cincinnati Eye Institute, and professor of ophthalmology, University of Cincinnati. "These include cases involving iris manipulation with hooks or rings, prolonged phaco time due to a dense cataract, capsule fixation or IOL suturing, and capsule tear or vitreous loss."