A Laboratory and Clinical Comparison of National Local Formulation and Universal Formulation of Topical Prednisolone Acetate 1% in Reducing Inflammation After Phacoemulsification

Purpose: To evaluate and compare the pharmacological characteristics and clinical efficacy of two topical steroid prednisolone preparations (Redmond®, prednisolone acetate 1%; and Pred Forte®, prednisolone acetate 1%) in reducing postoperative inflammation in patients having phacoemulsification surgery with IOL implantation, which will support our trust in national products considering it's availability and lower costs compared with universal products. Methods: I- Laboratory Study: Direct microscopic examination of the ophthalmic suspension for both formulations. II- Clinical Study: This study was interventional, prospective, randomized controlled study included 60 eyes of patients undergoing emulsification surgery with IOL implantation. Patients were assigned to one of two treatment groups, The first group (30 eyes) received Redmond® while the second group (30 eyes) received Pred Forte® in addition to standard therapy. Study drug was administered postoperatively every 2 hours while awake for 7 days, then four times daily for 7 days, then twice daily for 7 days, then once daily for 7 days. Clinical efficacy was compared for differences in visual acuity, anterior chamber cells (scale 0-4), fundus and macula, drug's ocular adverse effects: foreign body sensation and irritation (scale 1-3), and intraocular pressure (IOP). Results were compared on day 1, day 3, 1 week, 2 weeks, and 1 month postoperatively. Results: I- Average particle size in ophthalmic suspension for both formulations was (< 1 μm). (Redmond® = 0.95 μm, Pred Forte® = 0.77 μm). II- No statistical differences in clinical efficacy or safety were seen between the two formulations tested at any time point evaluated with respect to visual acuity, anterior chamber cells, fundus and macula, foreign body sensation and irritation, and intraocular pressure (IOP). Conclusions: In this study of routine cataract patients, both prednisolone acetate 1% formulations are comparably effective and safe when administered for the reduction of inflammation after phacoemulsification surgery with IOL implantation. Direct microscopic examination showed that both formulations achieved the condition that particle size in ophthalmic suspension must be less than one micron.

Comparison of Astigmatism Following Phacoemulsification Cataract Surgery with Superior Corneal Incision and Steepest Axis Corneal Incision

The purpose of this paper is to determine whether there is a difference in the postoperative corneal astigmatism and uncorrected visual acuity UCVA as well as best corrected visual acuity BCVA between 2 types of clear corneal incisions used in phacoemulsification: the superior and on the steepest clear corneal incision. This study included 40 patients with cataract and mild to moderate corneal astigmatism (0.50 D - 2.00 D) who underwent phacoemulsification with foldable posterior chamber lens (with 3.2mm corneal incision). Patients were randomly divided into two groups: superior clear corneal incision group SCCI (20 eyes) and on the steepest clear corneal incision group OCCI (20 eyes). Measurements included corneal astigmatism by Keratometry, UCVA and BCVA. These Measurements were taken on first day,1 week, 2 weeks,1, 2,3 and 6 months. The mean preoperative corneal astigmatism was (1.24 D ± 0.44),(1.25 D ± 0.44) in superior corneal incision group, and on the steepest corneal incision group, respectively. After 6 months postoperatively, the mean corneal astigmatism was (1.53 D ± 0.49) in SCCI group, (1.03 D± 0.39) in OCCI group, with statistically significant difference (p<0.001).There was statistically significant difference in UCVA. But there was no statistically significant difference in BCVA. The paper concludes that compared with SCCI, the OCCI could correct some corneal astigmatism

Anterior Corneal Surface Changes and Their Role in the Refractive Error after Phacoemulsification cataract Surgery

The study was performed on (50) eyes of (50) patients who attended the Ophthalmology Department at Al-Assad Hospital University in Lattakia, from Nov 2012 to Nov 2013. Our study included 32 (64%) males and 18 (36%) females who had senile cataract with mean age about (59.88±7.24 years). The aim was to study anterior corneal surface changes after phacoemulsification and the role of these changes in the refractive error after surgery. The patients were followed by regular periods during three months after surgery. In each visit, we recorded Best Correct Visual Acuity (BCVA), vertical, horizontal keratometry reading (K-reading) and sphere and astigmatic refraction errorby (Grand Seiko GRK-1 Auto Kerato-Refractometer) in a private data sheet for each patient. Results showed improving in BCVA from (0.27±0.1) before surgery to (0.92±0.16) three months after surgery. There was no significantstatistical value in steepening of horizontal meridian (0.12)D (P=0.13),but significant flattening in vertical meridian (0.21)D (P=0.0001), with no significant flattening in mean keratometric reading (0.05)D (P=0.215) three months after surgery. The mean of spherical refraction error after three months of surgery was (0.24±0.93)D. The refractive astigmatism after surgery was about (-1.08±0.74)D, and the keratometric astigmatism about (1.18±0.63)D, there was no significant difference between them(P=0.61).The Surgically Induced Astigmatism ( SIA) was about (0.47±0.38)D. There was no significant statistical value according to the keratometric astigmatism before and after surgery(P=0.785). So, we can say that the anterior corneal surface changes after phacoemulsification are responsible for (20.83%) of the spherical refractive error after surgery. The corneal astigmatism after surgery is interpreting the refractive astigmatism in about (76%) of patients and SIA is responsible for about (67%) of surgery induced refractive astigmatism.