Priming The Ocular Surface: Immuno-Inflammatory Modulation With Pre-Operative Topical Steroids In Cataract Surgery Patients

To evaluate the impact of short-pulse preoperative topical steroids on the status of ocular surface immuno-inflammatory factors in patients undergoing phacoemulsification, aiming to determine if "priming" the ocular surface improves the inflammatory profile post-surgery.

Tertiary eye care hospital in India

 In this prospective study, 40 patients were randomized into a control group (Ctl, n=17) and a test group (STx, n=23). The STx group received Prednisolone Acetate 1% (4x/day) for 3 days preoperatively. Tear fluid (TF) was collected preoperatively, on postoperative day 1 (POD1), and day 30 (POD30). Levels of Interleukin (IL)-1β, IL-6, IL-10, IL-17A, Tumor Necrosis Factor-alpha (TNFα), Matrix Metalloproteinase-9 (MMP9), Intercellular Adhesion Molecule 1 (ICAM1), and Vascular Endothelial Growth Factor-A (VEGF-A) were measured via multiplex ELISA.

Visual recovery was similar in both groups. IL-10 levels increased significantly in the STx group after the 3-day steroid pulse (p < 0.05). On POD1, MMP9 was significantly higher in the Ctl group compared to the STx group. By POD30, a significantly higher proportion of eyes in the STx group showed a decrease in IL-1β (≤ 1.5 fold) compared to the Ctl group. Conversely, the Ctl group showed a significantly higher proportion of eyes with increased IL-1β and IL-6 (≥ 1.5 fold) at POD30, indicating prolonged inflammation without preoperative priming.