One Drop Does Not Fit All – Personalised Post Operative Drop Regimens Following Routine Cataract Surgery.

Post-surgical inflammation, following routine cataract surgery, is controlled with prophylactic topical corticosteroids.  The Leader7 trial confirmed that 7 days of corticosteroid was non-inferior to 14 days and a lower risk of steroid induced raised intra ocular pressure.  Studies have identified that Black, Asian and Minority Ethnic (BAME) patients and those with a history of ocular inflmamation develop inflammation following routine cataract surgery despite prophylactic drops.  There is a risk that these patients are under treated.  Since June 2021 our eye hospitals have risk assessed patients pre-operatively for their risk of developing inflammation and personalised the duration of their drop regimen to either 2 weeks or 4 weeks.

37 eye hospitals in the United Kingdom, performing high volume cataract surgery. 

Retrospective real world case control study of patients undergoing routine cataract surgery in 2021 in a group of eye hospitals.  All patients had post operative reviews at 6 weeks.  Outcome measures included raised intra ocular pressure, incidence of corneal oedema, anterior uveitis, and cystoid macular oedema.   

In the first half of 2021, 37,548 patients received a 3 week course of topical corticosteroids, from June 2021; 49,372 patients received a two week duration of corticosteroids and 7792 higher risk patients received a 4 week course.  Respectively, incidence of raised IOP was 0.11%, 0.08% and 0.29% (OR 3.84, P<0.0001) corneal oedema 1.29%, 1.64% and 2.31% (OR 1.80, P<0.0001), anterior uveitis 3.10%, 1.01%, and 0.82% (OR 3.17, P<0.0001) and cystoid macular oedema 1.52%, 1.14% and 0.91% (OR 1.34, P<0.0001).          

Personalising post operative regimens resulted in an overall reduction of inflammation following routine cataract surgery.    A two week post operative regimen for low-risk patients following routine cataract surgery is non inferior to the mainstay longer treatment durations.  Overall inflammation reduced by treating high risk patients with a longer treatment duration.  Longer treatment durations were significantly associated with raised intra ocular pressure.