Clinical Research On Safe Period For Application Of Glucocorticoids After Cataract Surgery

BackgroundGlucocorticoids eye drops and cream are commonly used to prevent and treat anterior chamber reaction after cataract extract and intraocular lens implants. According to clinical observations and records, local and system application of glucocorticoids, especially local application of glucocorticoids , may cause corticosteroid-induced ocular hypertension and corticosteroid-induced glaucoma. According to zoopery and clinical observation, corticosteroid-induced ocular hypertension is related to type, time, and clinical observation, corticosteroid application, as well as inherited trait of individuals. Thus, the research on safe application of glucocorticoids after cataract surgery and on related factor that may trigger corticostercoid–induced glaucoma is very important in clinic.ObjectiveThe thesis is intended to research relation between corticosteroid-induced ocular hypertension after cataract surgery and time and frequency of application of corticosteroid, and to investigate proper time and frequency for application of corticosteroid in a wish that it may give some guide on application of corticosteroid after cataract surgery.Method1. Collect and research historic cases of phacoemusification and intraocular lens implant from January , 2005 to December, 2006. Split them into two groups by whether they are ocular hypertension or not. By historic analysis on the cases, summarize clinical features for glucocorticoids-induced ocular hypertension cases after the surgery. Conduct logistic regression analysis so as to understand influence by the factors(sex, age, time and dosage of glucocorticoids ,type of surgery ,other ocular complication, or other system diseases such as diabetes, high blood pressure,etc.) and interrelationship between the factors and glucocorticoids-induced ocular hypertension.2. Collect and research cases of phacoemusification and intraocular lens implant from April, 2007 to August, 2007. Split them into 4 groups at random by time sequence of surgery, apply glucocorticoids at different frequency and time as below:(1) Group A were applied OBRADEX eye drops(0.1% Dexamethasone + 0.3% Tobramycin), 6 times per day, and OBRADEX eye cream, once every night , for 2 weeks;(2) Group B were applied OBRADEX eye drops, 6 times per day, and OBRADEX eye cream, once every night , for 3 weeks;(3) Group C were applieded OBRADEX eye drops, 6 times per day, and OBRADEX eye cream, once every night , for 4 weeks;(4) Group D were applied OBRADEX eye drops, 6 times per day, and OBRADEX eye cream, once every night , for 4 weeks.Observe recession of anterior chamber reaction at the 1st , 3rd, 7 th,14th 20th , and 30th day after cataract surgery, and change of intraocular before surgery and on the 3 rd , 7th,14th, 30th , and 90th after surgery. Perform X2 examination, ANOVA, and rank sum test to understand effective and safe time for application of corticosteroid after cataract surgery.Result1. Conduct analysis on clinical records on patients who had been performed phacoemusification and intraocular lens implant during January, 2005 and December, 2006,and used glucocorticoids after the surgery. 1459 cases (1459 eyes) have been collected, among which are 511 males and 948 female.24 cases (24 eye ) showed glucocorticoids-induced ocular hypertension, among which were 14 malesand 10 females .Incidence for ocular hypertension is 1.63%.In patients who had been performed phacoemusification and intraocular lens implant, factors that have statistical prominence with occurrence of glucocorticoids-induced ocular hypertension are: age, high myopia, diabetes, pre-operative ocular injury, pre-operative uveitis, and complications during operation. Sex, high blood pressure, glaucoma, and lenticular nucleus grading do not have statistical prominence.2. Randomly separate 80 cases of patients that had been performed phcoemusification and intraocular lens implant during April, 2007 and August, 2007 in Daping Hospital into 4 groups in time sequence:(1) 13 patients (9 males and 4 females) of Group A were prescribed OBRADEx eye drops 6 times per day, and OBRADEx eye cream, once every night, for 2 weeks:(2) 28 patients (6 males and 22 females) of Group B were prescribed OBRADEx eye drops 6 times per day, and OBRADEx eye cream, once every night, for 3 weeks:(3) 17 patients (10 males and 7 females) of Group C were prescribed OBRADEx eye drops 6 times per day, and OBRADEx eye cream, once every night, for 4 weeks:(4) 22 patients (7 males and 15 females) of Group D were prescribed OBRADEx eye drops 3 times per day, and OBRADEx eye cream, once every night, for 4 weeks.There are not prominent difference on age, sex, and types of eye in each group. There are also not prominent differences on general score of symptom and physical sign one day after surgery, aqueous flare, and cell statistics. Post-operative reaction: There are not prominent differences on general scores of symptom and physical at 3 rd ,7 th, 14 th, and 30 th day after surgery in the four medication means by Mann-Whitney Test, while aqueous flare does not have prominent difference except for post post-operative period. There is not statistical difference on cellular reaction on aqueous cells at 30 days after surgery. There are not statistical differences for all groups by comparisons before surgery, at 14 days after surgery, and at 30 days after surgery. Ocular tensions of all are within normal range.Conclusion:1. 1459 cases (1459 eyes ) of phacoemusification and intraocular lens implant have been collected for the research, among which are 511 males and 948 females. 24 cases (24 eyes ) showed glucocorticoids-induced ocular hypertension, among which were 14 males and 110 females. Incidence for ocular hypertension is 1.63%.In patients who had been performed phacoemusification and intraocular lens implant , factors that have statistical prominence with occurrence of glucocoticoids-induced ocular hypertension are: high myopia, diabetes, pre_operative ocular injury, pre-operative uveitis, and complications during operation. Sex, age, high blood pressure, glaucoma, and lenticular nucleus grading do not have statistical prominence. 2. There are not prominent differences on age, sex, and types of eye in each group. There are also not prominent differences on general score of symptom and physical sign one day after sugery, apueous flare, and cell statistics. There are not statistical differences for all groups by comparisions before surgery, at 14 days after surgery, and at 30 days after surgery. None of ocular tension of cases is found beyond normal range. So we concluded that it is safe for intraocular pressure of phacoemusification and intraocular lens implant after 4 weeks of OBRADEx eye drops, and it is useful for the control of cellular reaction.