| Setting and ObjectiveCataract extraction combined intraocular lens (IOL) implantation is commonly used for anterior uveitis complicated cataract. For intraocular lens irritation and posterior synechiolysis is often required, patients are frequently complicated by fibrin formation in anterior chamber, or lens frontal membrane which decreases visual acuity and Nd: YAG (neodymium: yttrium aluminum garnet) laser or surgery therapy is needed. Presently, glucocorticoid eyedrops or dexamethasone,hyaluronidase subconjunctival injection are generally used to prevent postoperative fibrin formation, but we have to repeatedly inject because drugs act on short time and quickly absorbed, additionally, the risk of scleral perforation and corneal epithelium stripping is increased.With the method of anterior chamber injection, drugs can directly act on target organ and maintain higher drug concentration in anterior chamber, thereby reduce medication dosage,frequency and complication. Triamcinolone acetonide is a kind of long acting glucocorticoid. Recently, it is widely used for intravitreous injection to treat ocular posterior segment diseases and assist vitrectomy as stain agent. It is reported abroad that intraoperative anterior chamber injection of triamcinolone acetonide is effective in preventing postoperative fibrin formation after cataract surgery in patients with iridocyclitis (no IOL was implanted), and no increase in intraocular pressure was noted after surgery. There is no domestic report of anterior chamber injection of triamcinolone acetonide.By clinical observation, this study aims to assess the efficacy and security of anterior chamber injection of triamcinolone acetonide during cataract extraction combined IOL implantation to lighten postoperative fibrin formation in anterior chamber for patients with anterior uveitis complicated cataract, and also may offer evidence for preventing postoperative fibrin formation that resulting from surgery of different types of cataract.Information and Methods1. 68 cases (68 eyes) with anterior uveitis complicated cataract were divided into two groups randomly, injected group and control group, eliminating retinal detachment,vitreous opacity and other ocular diseases with B ultrasound preoperatively. The mean age(injected group 30.32±9.10 years old, control group 29.44±9.00 years old) and the mean inflammation stabilization time (injected group 2.88±0.86 years, control group 2.83±0.98 years) in the two groups were close to each other, and they were all followed up for 3 to 6 months.2. Small incision extracapsular cataract extraction combined IOL implantation was used. In injected group (34 cases) , triamcinolone acetonide 2 mg (0.05ml) was injected into the anterior chamber through the tunnel incision at the end of the surgery. Another 34 patients in control group were without triamcinolone acetonide injected into the anterior chamber. Postoperatively, TobraDex(tobramycin 0.3% and dexamethasone 0.1%) eyedrops were routinely given. Acrylate posterior chamber IOLs made in American AMO corporation were selected for all the patients. All the operations were performed by the same doctor.3. Fibrin formation in anterior chamber in both groups were observed by slit lamp postoperatively and were divided into slight,midrange and severe degree. Topcon SBP-2000P corneal endothelium count made in Japan was used to measure corneal endothelial cell density of the two groups preoperatively and 1 week,4 weeks,8 weeks,12 weeks postoperatively. Schiotz ophthalmotonometer was adopted to measure intraocular pressure in the two groups preoperatively and 1 day,2 days,3 days,7 days postoperatively.4. SPSS 12.0 package was adopted to carry out statistical analysis, data of fibrin formation using x~2 test while data of corneal endothelial cell density and intraocular pressure using paired t-test,α=0.05 was taken as the significance test.Results1. Postoperative fibrin formation in injected group were mainly no and slight fibrin formation, cases with different degree of fibrin formation in control group were all more than that in injected group, group comparison, x~2=8.36, P<0.05, postoperative fibrin formation in injected group was obviously lighter than that in control group.2. Corneal endothelial cell density of both groups decreased in a degree postoperatively, but in different phases that pre-operation,4 weeks,8 weeks and 12 weeks after operation, there was no statistical difference in corneal endothelial cell density between the two groups (P>0.05) .3. Intraocular pressure of both groups fluctuated slightly after operation, but in different phases that pre-operation,1 days,2 days,3 days and 7 days after operation, there was no statistical difference in intraocular pressure between the two groups (P>0.05) .ConclusionAnterior chamber injection of triamcinolone acetonide during cataract extraction combined IOL implantation can effectively lighten postoperative fibrin formation in anterior chamber for patients with anterior uveitis complicated cataract, it is an effective and safe medication that has little influence on corneal endothelium and intraocular pressure. |
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