From the Guidelines
After cataract surgery, patients should follow a treatment regimen that includes antibiotic drops, steroid drops, and non-steroidal anti-inflammatory drops to prevent infection, reduce inflammation, and promote healing, as well as follow a specific postoperative care plan to optimize visual outcomes and prevent complications, as recommended by the most recent study 1. The standard treatment includes antibiotic drops like moxifloxacin or gatifloxacin four times daily for 1-2 weeks to prevent infection, as well as intracameral antibiotic administration to reduce the risk of postoperative bacterial endophthalmitis 1. Steroid drops such as prednisolone acetate 1% are used four times daily for the first week, then tapered over 3-4 weeks to reduce inflammation. Some patients also need non-steroidal anti-inflammatory drops like ketorolac or nepafenac twice daily for 2-4 weeks to manage pain and swelling, as they reduce the incidence of early postoperative cystoid macular edema (CME) 1. Patients should avoid rubbing their eyes, swimming, or getting water in the eye for at least a week. They should wear protective eyewear during the day and an eye shield while sleeping for the first week. Follow-up appointments are typically scheduled one day after surgery, then at one week, and again at one month, and should include a comprehensive examination, including interval history, measurement of visual function, measurement of IOP, slit-lamp biomicroscopy, and counseling/education for the patient or patient’s caretaker 1. These medications and precautions are crucial because the eye is vulnerable to infection and inflammation after surgery, which could compromise visual outcomes. Most patients experience improved vision within a few days, though complete healing may take several weeks. Additionally, patients should be proactive in managing dry eye disease (DED) after cataract surgery, and preservative-free artificial tears, topical steroids, and topical NSAIDs are recommended for use within the first post-surgical month, with further treatment tailored to the individual patient's needs 1.
From the Research
Treatment Post Cataract Surgery
- The treatment post cataract surgery often involves the use of anti-inflammatory medications to reduce inflammation and prevent complications such as cystoid macular edema (CME) 2, 3, 4, 5, 6.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for this purpose, and have been shown to be effective in reducing pain, preventing intraoperative miosis, and modulating postoperative inflammation 3, 6.
- The use of NSAIDs in combination with steroids has also been studied, with some research suggesting that this combination may be more effective in controlling early postoperative inflammation than NSAIDs alone 2.
- However, other studies have found that the use of NSAIDs alone may be sufficient for controlling postoperative inflammation, and that the addition of steroids may not provide significant additional benefits 2, 3.
- It is also important to note that NSAIDs can cause adverse side effects, including ocular surface abnormalities, and therefore must be used with caution and carefully selected to improve surgical outcomes and patient satisfaction 5, 6.
Medications Used
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac and Voltaren are commonly used to control postoperative inflammation and prevent CME 2, 3, 6.
- Steroids such as prednisolone and dexamethasone are also used to control postoperative inflammation, although their use may be associated with an increased risk of intraocular pressure elevation 2, 3.
- Newer corticosteroids such as rimexolone and loteprednol etabonate may offer good anti-inflammatory efficacy with reduced risk of intraocular pressure elevation 3.
Postoperative Care
- Postoperative care after cataract surgery typically involves the use of prophylactic medications to prevent infection and inflammation, as well as restrictions on activities to minimize the risk of complications 4.
- Follow-up care is also important to monitor for potential complications and adjust treatment as needed 4.
- The management of postoperative visual expectations can be challenging, particularly in patients receiving newer advanced technology intraocular lenses (IOLs) 4.