What is the recommended treatment for post-operative cataract surgery inflammation and photosensitivity?

Management of Post-Operative Cataract Surgery Inflammation and Photosensitivity

For post-operative cataract surgery inflammation and photosensitivity, the recommended treatment includes preservative-free artificial tears, topical steroids, and topical NSAIDs within the first post-surgical month, with preservative-free formulations preferred to minimize ocular surface irritation. 1

First-Line Treatment Regimen

Anti-inflammatory Medications

• Topical steroids:

  • Prednisolone acetate 1% ophthalmic suspension: 4 times daily for the first 2 weeks post-surgery
  • Taper over a period of days to weeks depending on inflammation severity
  • Monitor for corticosteroid-related side effects, particularly IOP elevation

• Topical NSAIDs:

  • Ketorolac tromethamine ophthalmic solution: 1 drop 4 times daily beginning 24 hours after surgery and continuing through the first 2 weeks 2
  • Can be safely administered with other ophthalmic medications including antibiotics and steroids

Photosensitivity Management

• Preservative-free artificial tears (ATs) as needed to maintain ocular surface hydration
• Consider tinted glasses for outdoor activities to reduce photosensitivity
• Avoid bright lights and digital screens for prolonged periods during early recovery

Follow-up Schedule

Following the Taiwan Society of Cataract and Refractive Surgeons recommendations 1:

1. Day 1 post-surgery:

   • Check for signs of infection or inflammation
   • Assess intraocular pressure

2. Weeks 1-2 post-surgery:

   • Evaluate for infection, dry eye occurrence, or ocular surface damage
   • Assess visual acuity and intraocular pressure
   • Perform tear break-up time (TBUT) examination
   • Initiate additional treatment if necessary

3. 1 month post-surgery:

   • Evaluate treatment effect
   • Assess visual acuity and intraocular pressure
   • Perform TBUT examination

Evidence-Based Considerations

Efficacy of Anti-inflammatory Regimens

• High-quality evidence shows topical NSAIDs are more effective than topical steroids alone in preventing pseudophakic cystoid macular edema (PCME) 3
• Combination therapy with both NSAIDs and steroids provides optimal control of inflammation in most cases 4
• Ketorolac has demonstrated effectiveness in reducing prostaglandin E2 levels in aqueous humor, which mediates intraocular inflammation 2

Dry Eye Management

Cataract surgery is known to cause or exacerbate pre-existing dry eye disease (DED), which can contribute to inflammation and photosensitivity 1. Management should include:

• Preservative-free artificial tears
• More frequent administration of DED therapy after surgery than before
• Consideration of punctal plugs, topical autologous serum, or topical cyclosporine after the first month if DED persists

Important Caveats and Pitfalls

1. Monitoring for steroid-related complications:

   • Check for corticosteroid-related side effects such as elevated IOP
   • IOP will become elevated in a significant proportion of patients with prolonged corticosteroid use 1

2. Differentiating inflammation from infection:

   • Corneal infiltrates associated with NSAID drops without concomitant corticosteroids have been reported
   • Consider microbial keratitis whenever a corneal infiltrate is seen 1

3. Preservative toxicity:

   • Preservatives are a source of ocular irritation
   • Preservative-free eye-drop regimens are recommended, especially in high-risk patients 1

4. Delayed epithelialization:

   • Anesthetic and NSAID drops may delay corneal epithelialization and should be prescribed judiciously 1

By following this evidence-based approach to managing post-cataract surgery inflammation and photosensitivity, patients can achieve optimal visual outcomes while minimizing complications.