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Triamcinolone acetonide-moxifloxacin controls inflammation after cataract surgery
An injection of triamcinolone acetonide-moxifloxacin controlled intraocular inflammation and corneal edema after cataract surgery.
The retrospective longitudinal comparative study included 681 eyes (group 1) that received Tri-Moxi (triamcinolone acetonide-moxifloxacin, Imprimis Pharmaceuticals) and an NSAID after undergoing cataract surgery. This group was compared with 514 eyes (group 2) that received a standard eye drop therapy of antibiotic, corticosteroid and NSAID after cataract surgery.
Researchers evaluated postoperative inflammation, corneal edema and the rate of high IOP between the two groups.
Anterior chamber cell reaction severity in group 1 decreased by 34% at 1 week postoperative and 35.7% at 1 month postoperative compared with group 2 (P = .001 and P = .02, respectively).
Group 2 had a lower degree of corneal edema on postoperative day 1 (P = .001), but there was no significant difference in corneal edema severity between the two groups at later follow-up visits.
Rate of high IOP was not significantly different between the groups during any postoperative timepoints.
“Triamcinolone acetonide-moxifloxacin injection can be considered as a promising substitute
for standard eye drop therapy, especially in patients who have poor compliance with eye drop use,” the study authors wrote. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The authors present a retrospective review of intraocular inflammation control and corneal edema in 681 patients receiving intravitreal triamcinolone acetonide-moxifloxacin injection and a postoperative NSAID compared with 514 patients using standard topical eye drops. Inflammation control is paramount postoperatively, and eye drop compliance has commonly been an issue in our post-cataract surgery patient population. Intracameral antibiotic use has been associated with a lower endophthalmitis rate in several studies.
The present study shows that intravitreal triamcinolone acetonide-moxifloxacin injection can be as effective as topical drops and decreases the patient burden by using one drop postoperatively instead of multiple drops. Inflammation was well controlled in both groups but was reduced at a faster rate in the injection group, although this did not impact incidence of cystoid macular edema or rate of infection. A major question is the safety of intravitreal injection at the time of cataract surgery, which was not assessed by the authors. Large studies assessing risk of retinal tear or detachment should be undertaken to truly identify if the potential benefits outweigh the risks. Another consideration in determining utilization of postoperative intracameral or intravitreal injections is cost and who bears the cost of these medications used intraoperatively. Studies continue to support the efficacy of these treatments, but currently the surgeons and/or patients are bearing the cost, which may not be sustainable.
Overall, inflammation control and infection prevention are paramount in the postoperative patient. We have more options today than in the past, and clinicians should consider alternative drug delivery models to solve the issues of patient noncompliance. However, it is critical to evaluate both the risks and benefits of any new technology.