The exact pathogenesis of PCMO remains unclear, although it is thought to be multifactorial. It is known that surgical manipulation in the anterior chamber may cause the release of arachidonic acid from uveal tissue.7<\/span>\u00a0Arachidonic acid is metabolised into prostaglandins, which are inflammatory mediators that cause swelling of the fovea by increasing vascular permeability and fluid accumulation due to the breakdown of the blood\u2013aqueous and blood\u2013retinal barriers.8,9<\/span>\u00a0PCMO is thought to be a common cause of unsatisfactory functional outcome with a prevalence ranging from 0.10\u20132.35%.9<\/span>\u00a0Incidence of PCMO depends on how cystoid macular oedema is defined.6<\/span>\u00a0In patients who are not diabetic and without ocular risk factors, such as iris trauma and vitreous loss, the incidence is 1.17%.10<\/span>\u00a0Not all cases of PCMO experience functional impairment, and these are called sub-clinical PCMO. Conversely those eyes with visual impairment are designated clinically significant.<\/p>\n A decrease in visual acuity is not always present, but fluorescein angiography can show evidence of macular oedema. The presence of PCMO can be determined by using optical coherence tomography (OCT) \u2013 diagnostic tool that allows objective measurement of changes in retina volume. The incidence of PCMO defined by OCT after uncomplicated phacoemulsification in a recent study was found to be 2.72%.11<\/span>\u00a0Usually mild subclinical episodes of PCMO resolve spontaneously.12<\/span>\u00a0Lobo et al. have shown that macular oedema reaches a maximum at 6 weeks, after which, most cases led to recovery; although seven eyes (22%) still had macular oedema in 30 weeks.13<\/span>\u00a0Henderson et al. reported that PCMO in patients after cataract surgery resolved in 249.0 \u00b1 2.8 days with no treatment, and that patients treated with combined NSAIDs and corticosteroids had significantly shorter resolution times of 82.6 \u00b1 56.9 days.14<\/span>\u00a0Most reports favour treatment for cases of clinically significant PCMO to prevent irreversible damage to the macula.6<\/span><\/p>\n Pseudophakic cystoid macular oedema risk factors<\/p>\n PCMO may occur in healthy eyes without risk factors after uncomplicated cataract surgery, although it is more often in contralateral PCMO, diabetes mellitus, uveitis, retinal vein occlusion, retinal degeneration, macular degeneration, radiation retinopathy, epiretinal membranes, choroidal tumours and aging.10,15\u201317<\/span>\u00a0Patients with diabetes, even without diabetic retinopathy, have increased risk in developing PCMO after cataract surgery, as poor glycaemic control is associated with a risk of postoperative macular edema.18<\/span>\u00a0Accumulation of inflammatory cytokine concentrations in ocular tissues may contribute to early neuronal cell death in the retina.19<\/span>\u00a0Hyperglycaemia increases concentration of circulating cytokines due to oxidation mechanisms.20<\/span>\u00a0Raised levels of inflammatory and proliferative factors may contribute to pathogenesis of proliferative diabetic retinopathy (PDR) and even correlate with the severity of PDR (interleukin 6 [IL-6], vascular endothelial growth factor [VEGF], transforming growth factor [TGFb<\/span>-1]).18,21<\/span>\u00a0Risk of PCMO was found to be proportionate to the severity of diabetic retinopathy.10<\/span>\u00a0In a multicentre database study was conducted by Denniston et al. which included patients undergoing cataract surgery with diabetes and no history of diabetic macular oedema. In the first year after surgery risk of developing diabetic macular oedema which required treatment was 1.0% for patients with no diabetic retinopathy preoperatively, 5.4% for patients with mild non-proliferative diabetic retinopathy (NPDR), 10.0% for moderate, and 13.1% for severe NPDR.22<\/span>\u00a0In a study conducted by Yang et al., risk factors for PCMO after cataract surgery were duration, severity and type of diabetes; hardness of the lens; and glycated haemoglobin (HbA1c) levels.23<\/span>\u00a0Patient allergy and atopy have not been found to increase the risk of PCMO.24<\/span><\/p>\n Nonsteroidal anti-inflammatory drugs<\/p>\n NSAIDs are chemical compounds, which inhibit cyclooxygenase (COX) enzymes and therefore inhibit the synthesis of prostaglandins.4<\/span>\u00a0The US Food and Drug Administration (FDA) approved the following topical NSAIDs: nepafenac, bromfenac, ketorolac, diclofenac and flurbiprofen (Table 1<\/span>). Indications for use of them are inflammation and pain associated with cataract surgery, corneal refractive surgery, inhibition of intraoperative miosis and seasonal allergic conjunctivitis.25<\/span>\u00a0NSAIDs are not FDA indicated for the treatment of PCMO; however, they may be beneficial in increasing the speed of visual recovery in the first several weeks after cataract surgery.12<\/span>\u00a0Topical NSAIDs may cause some side effects such as transient burning, punctate keratitis and corneal epithelial defects.4,26<\/span>\u00a0NSAIDs may cause cytotoxic reactions which can lead to significant corneal alterations such as corneal melts.27<\/span><\/p>\n Diclofenac<\/p>\n Diclofenac sodium 0.1% is a derivative of phenyl acetic acid and one of the most commonly used NSAIDs. In randomised controlled trial, Medic\u00b4 et al. showed significantly lower IL-12 levels in the aqueous humour of patients with diabetic retinopathy using diclofenac 0.1% four times a day for 7 days, compared to placebo. The same study compared central foveal thickness 30 days after surgery in two groups treated with either diclofenac 0.1% or dexamethasone 0.1%, and reported lower incidence of postoperative macular oedema in the NSAID group.27<\/span>\u00a0A combination of cyclodextrin (cyclic oligosaccharide) with diclofenac may lower ocular toxicity and enhance corneal tolerability.28<\/span><\/p>\n Nepafenac<\/p>\n Nepafenac is a potent prodrug which is converted to its active metabolite, amfenac, by intraocular hydrolases.29<\/span>\u00a0Amfenac suppresses prostaglandin synthesis by inhibiting COX-1 and COX-2. In study conducted by Walters et al., amfenac showed greater potency at COX-2 inhibition than ketorolac 0.4% and bromfenac 0.09%.30<\/span>\u00a0Nepafenac 0.1% is also considered to be safe on the ocular surface after surgery. In a prospective randomised trial, postoperative corneal staining was compared when using nepafenac 0.1% or diclofenac 0.1% beginning 3 hours before surgery and three times a day for 4 weeks postoperatively. Patients in the diclofenac group had significantly higher corneal staining scores 4 weeks postoperatively.31<\/span>\u00a0Tzelikis et al. reported nepafenac 0.3% once daily, starting 2 days before surgery and 5 weeks after, was effective in reducing macular thickness compared to placebo, although without a difference in visual acuity (all patients received prednisolone acetate for 5 weeks postoperatively).32<\/span><\/p>\n Bromfenac<\/p>\n Bromfenac is an NSAID which is available in different concentrations: 0.07%, 0.075% and 0.09%. It is used to treat postoperative inflammation and ocular pain after cataract surgery, although it is not indicated for the prevention or treatment of PCMO.33<\/span>\u00a0Bromfenac 0.09% has good ocular penetration properties and has been found to maintain stable concentration in the aqueous humour up to 12 hours after instillation.34<\/span>\u00a0Bromfenac 0.07% and 0.09% ocular distribution were compared in a 12-hour study with rabbits, and no significant difference in ocular tissue between concentrations was found.35<\/span>\u00a0Bromfenac 0.075% (BromSite\u00ae<\/span>; Sun Ophthalmics, Princeton New Jersey, USA) is relatively new compound formulated with the DuraSite\u00ae<\/span>\u00a0delivery system (Sun Ophthalmics),\u00a0<\/span>a mucoadhesive matrix contributing to longer ocular surface dwelling time.25<\/span>\u00a0Sheppard et al. conducted an\u00a0in vivo<\/span>\u00a0study with rabbits, comparing the pharmacokinetics of bromfenac 0.075%, bromfenac 0.7% and nepafenac\/amfenac 0.3% ophthalmic solutions. This study showed similar ocular distribution patterns in both the anterior and posterior segments, although bromfenac 0.075% (BromSite) showed significantly higher concentrations in ocular tissues.25<\/span>\u00a0In an\u00a0ex vivo<\/span>\u00a0study performed in human aqueous humour, bromfenac concentration was significantly higher in subjects receiving DuraSite containing bromfenac 0.075% than bromfenac 0.09% after 3 days of dosing.36<\/span><\/p>\n In several studies, bromfenac was shown to be quite well tolerated. In a study conducted by Chinchurreta Capote et al.,\u00a0<\/span>none of the patients complained of eye stickiness when using bromfenac compared to 13.8% of patients in nepafenac group and 10.3% of patients treated with diclofenac sodium. This observational comparative study using post-surgical satisfaction questionnaire showed that bromfenac is well tolerated; moreover, bromfenac was found to be more effective than diclofenac and nepafenac in reducing PCMO after phacoemulsification.37<\/span>\u00a0In another randomised controlled study, bromfenac 0.09% was also found to be better tolerated than diclofenac 0.1%; although diclofenac appeared to be more effective in reducing postoperative inflammation in terms of anterior chamber laser flare-cell photometry and central foveal thickness.38<\/span><\/p>\n Ketorolac<\/p>\n Ketorolac tromethamine is a NSAID, usually used to manage pain, including during eye surgery. Ketorolac tromethamine 0.5% has been shown to be equally effective as diclofenac sodium 0.1% in reducing the severity and duration of PCMO after cataract surgery.39<\/span>\u00a0Ketorolac 0.045% ophthalmic solution containing carboxymethylcellulose was developed relatively recently. Attar et al. reported that formulation of ketorolac 0.045%, pH 6.8, increased the bioavailability in aqueous humour and iris-ciliary body more so than ketorolac 0.4%, pH 7.4.40<\/span>\u00a0Waterbury et al. reported higher concentrations of ketorolac 0.045% in animal ocular tissues than bromfenac 0.09%.41<\/span><\/p>\n Corticosteroids<\/p>\n Corticosteroids act as phospholipase-A2 inhibitors and prevent the release of arachidonic acid which can be metabolised to leukotrienes and prostaglandins. (Table 2<\/span>)<\/span>42<\/span>\u00a0This class of drugs also prevent epithelial adhesion, chemotaxis, phagocytosis.12<\/span>\u00a0Adverse effects of topical corticosteroids use include IOP elevation, impaired wound healing, infection and development of cataracts.43<\/span><\/p>\n Dexamethasone<\/p>\n Dexamethasone eye drops may be applied topically after cataract surgery. Dexamethasone disodium phosphate eye drops have been found to have low penetration to aqueous humour and vitreous compared to other administration routes (peribulbar or subconjunctival injection).44<\/span>\u00a0Dexamethasone disodium phosphate suspension gives three-times higher concentration in the aqueous humour when applied topically compared to dexamethasone solution.45<\/span>\u00a0In a randomised, double-blind, prospective study, Ylinen et al. showed that dexamethasone monotherapy (1 mg\/mL three times a day for 3 weeks) after cataract surgery had lower effect compared to diclofenac (1 mg\/mL three times a day for 3 weeks) or dexamethasone and diclofenac.46<\/span>\u00a0No significant difference in preventing PCMO was found when comparing postoperative use of prednisolone acetate to dexamethasone phosphate.47<\/span>\u00a0Klamann et al. showed that an intravitreal 0.7 mg dexamethasone implant may be effective in postoperative macular oedema treatment.48<\/span><\/p>\n Prednisolone<\/p>\n Prednisolone acetate 1.0% is one of the most frequently used corticosteroids after cataract surgery. Prednisolone is a synthetic analogue of the glucocorticoid hydrocortisone. It has good ocular penetration characteristics and is relatively the most effective anti-inflammatory agent for anterior segment ocular inflammation.49<\/span><\/p>\n Difluprednate<\/p>\n Difluprednate or\u00a0<\/span>difluoroprednisolone butyrate acetate are modifications of prednisolone to increase its potency \u2013 affinity for the glucocorticoid receptor and enhance tissue penetration. It was approved by FDA in 2008,50<\/span>\u00a0and is available in 0.05% ophthalmic solution. Garg et al.\u00a0<\/span>reported 0.05 difluprednate used six times a day for 4 weeks compared to prednisolone acetate 1.0% six times a day for 4 weeks is equally Triamcinolone acetonide<\/p>\n Subconjunctival triamcinolone acetonide may provide a prolonged anti-inflammatory effect after cataract surgery. Lindholm et al. reported a good effect on postoperative central retinal thickness and aqueous flare of 20 mg (0.5 mL; 40 mg\/mL) with a perioperative subconjunctival injection of triamcinolone acetonide after cataract surgery, compared to daily dexamethasone 1 mg\/mL three times a day for 3 weeks. No serious adverse events were observed in 90-day period.52<\/span>\u00a0Y\u00fc<\/span>ksel et al. compared 40 mg sub-Tenon triamcinolone acetonide injection to twice-daily topical nepafenac 0.1% and found that both treatment modalities are effective; although nepafenac was more efficacious in terms of visual gain.53<\/span>\u00a0In a randomised controlled trial, PREMED Study Report 2, subconjunctival injection of 40 mg triamcinolone acetonide was used as additional treatment for diabetic patients undergoing phacoemulsification cataract surgery. Macular thickness and macular volume were found to be lower at weeks 6 and 12, postoperatively, in patients who received triamcinolone than patients who did not.54<\/span><\/p>\n Prevention of pseudophakic cystoid macular oedema<\/p>\n Due to spontaneous resolution of most uncomplicated PCMO cases, practice patterns of PCMO prevention differ. There is an opinion that prophylaxis of PCMO is unnecessary if patients have no risk factors.55<\/span>\u00a0Cataract surgery guidelines from the American Academy of Ophthalmology (AAO) recommend using NSAIDs only in high-risk cases, such as diabetic retinopathy.56<\/span>\u00a0The National Institute for Health and Care Excellence (NICE) recommends to consider using a combination of topical steroids and NSAIDs after cataract surgery for people with increased risk of PCMO, for example, patients with diabetes or uveitis. Topical steroids and\/or NSAIDs may be offered after cataract surgery to prevent inflammation and PCMO.57<\/span>\u00a0The Canadian Ophthalmology Society recommends using topical steroids, NSAIDs or both in all intraocular surgery.58<\/span><\/p>\n Inflammation after cataract surgery may be controlled using topical NSAIDs or steroids (Table 3<\/span>). Kessel et al. performed a systematic literature review and found that topical NSAIDs are more effective than topical steroids, and therefore recommend using them to prevent PCMO after cataract surgery.8<\/span>\u00a0Although, this review was criticised for not discussing studies in which no difference in macular volume was found when comparing NSAIDs and placebo, and not including existing recommendations for the prevention of postoperative inflammation and PCMO.59<\/span>\u00a0Moreover, a Cochrane systematic review has shown that value of using NSAIDs as an alternative to, or in combination with, topical steroids to prevent vision loss after cataract surgery, is uncertain.60<\/span><\/p>\n Almeida et al.\u00a0<\/span>evaluated the efficacy of ketorolac 0.5% versus nepafenac 0.1% on macular volume 1 month after cataract surgery. Patients were divided in three groups and received ketorolac 0.5%, nepafenac 0.1% or placebo. Patients were instructed to instil one drop four times a day, 1 day preoperatively and for 4 weeks postoperatively. All patients received prednisolone 1.0% for 4 weeks. No significant difference in central subfield thickness postoperatively was found between the groups.61<\/span><\/p>\n Ramakrishnan et al.\u00a0<\/span>compared the effects of 0.1% nepafenac and 0.4% ketorolac on central macular thickness after cataract surgery. Both groups received prednisolone 1.0% one month postoperatively and NSAID drops three times a day 1 day preoperatively and 30 days postoperatively. Central macular thickness 1 month postoperatively was not significant differently.62<\/span><\/p>\n There are studies showing the superior effect of NSAIDs in combination with steroids than steroids alone. Zaczek et al.\u00a0<\/span>compared two groups of patients, one received nepafenac 0.1% three times a day starting 2 days preoperatively and continued 3 weeks after and dexamethasone 0.1% three times a day for 3 weeks after cataract surgery, and other group received dexamethasone 0.1% alone. The combination of NSAID and steroid was found to have greater effect on reducing subclinical macular swelling than steroid alone.63<\/span><\/p>\n Jung et al. reported a beneficial effect of bromfenac 0.1% (one drop twice daily starting 3 days before cataract surgery and for 4 weeks postoperatively) or ketorolac 0.45% (one drop twice daily starting 1 day before surgery and continuing 2 weeks postoperatively) compared to prednisolone alone after cataract surgery in reducing postoperative inflammation and macular changes. All patients in the three groups received topical gatifloxacin 0.3% and prednisolone acetate 1.0% for 4 weeks postoperatively.64<\/span>\u00a0In another study conducted by Pollack et al. patients were randomised to two groups, the first group using nepafenac 0.1% three times daily starting 1 day before surgery and 90 days after; and the second group using vehicle. Both groups of patients received dexamethasone 0.1% four times daily for 2 weeks postoperatively. The NSAID\u2013steroid combination group showed a significantly lower percentage of eyes developing macular oedema within 90 days after cataract surgery.65<\/span>\u00a0Campa et al.\u00a0<\/span>found that bromfenac 0.09% (one drop two times a day for 3 days before surgery and 15 days after) or nepafenac 0.01% (one drop three times a day for 3 days before surgery and 4 weeks after) usage with dexamethasone sodium phosphate 1.32 mg and netilmicin sulphate 4.55 mg (four times daily for 4 weeks after surgery) are associated with reduced incidence of PCMO than using dexamethasone alone.66<\/span>\u00a0Toyos compared two groups of patients undergoing phacoemulsification using only once-daily bromfenac 0.07% or nepafenac 0.3% solutions and found no significant difference in terms of retinal thickness increase.67<\/span><\/p>\n Randomised controlled clinical trial PREMED (the prevention of macular oedema after cataract surgery) compared different prevention methods in patients without (PREMED Study Report 1) and with (PREMED Study report 2) diabetes across 12 European study centers. Study Report 1 compared NSAID, corticosteroids and their combination in the prevention of PCMO in nondiabetic patients after cataract surgery. There were three groups of patients: the first one received bromfenac 0.09% twice daily 2 days preoperatively and 2 weeks postoperatively, second group received dexamethasone 0.1% 4 times daily 2 days preoperatively and 2 weeks postoperatively, third group used combination of these two drugs. Patients underwent ophthalmologic examination at baseline and had follow-up visits at 6 and 12 weeks postoperatively. The study results showed that patients who received combination of bromfenac 0.09% and dexamethasone 0.1% had lowest postoperative macular thickness and the risk of developing clinically significant PCMO was lower than in patients treated only with bromfenac or dexamethasone. Visual acuity between the groups were not significantly different at 6 and 12 weeks postoperatively. Although PCMO incidence, which developed at 6 weeks postoperatively in most cases, was significantly lowest in combination group.68<\/span><\/p>\n In PREMED Study Report 2, all patients who underwent phacoemulsification received treatment with bromfenac and dexamethasone eyedrops. Patients were allocated into four groups according to the additional treatment they received. The first group were prescribed subconjunctival injection of triamcinolone acetonide, the second group received intravitreal injection of bevacizumab, the third group received both medications, and the fourth group got no additional treatment.57<\/span>\u00a0Almost all patients included in the study were diagnosed with diabetes mellitus and most of them had no signs of diabetic retinopathy at the time of surgery. An extensive ophthalmologic examination was performed on the study eye, including subjective refraction, corrected distance visual acuity, slit lamp examination, tonometry, fundoscopic examination and macular thickness measurements using OCT. Patients had follow-up visits 6 and 12 weeks postoperatively and underwent ophthalmologic examination. The results of this trial show that patients who had subconjunctival injection of triamcinolone acetate postoperatively had lower mean central subfield macular thickness than patients who had not had triamcinolone acetate. Additionally, none of patients in this treatment group developed cystoid macular oedema. Although, IOP was significantly higher in patients who received the subconjunctival injection of triamcinolone acetate than patients in other groups. However, based on the results of the PREMED study, triamcinolone acetate injections are not recommended for all diabetic patients undergoing cataract surgery considering the low overall incidence of postoperative PCMO and increased IOP.54<\/span><\/p>\n None of these studies demonstrate a significant effect on visual acuity over longer periods (>3 months) after cataract surgery. Kim et al. performed literature review on the effectiveness of topical NSAIDs in preventing PCMO. They concluded that there is a lack of level 1 evidence to support the long-term efficacy of NSAIDs in preventing vision loss for >3 months after surgery; however, NSAIDs may improve the speed of visual recovery postoperatively.12<\/span>\u00a0Pollack et al. analysed the change in best corrected visual acuity from baseline to day 90 after cataract surgery and found that the change was greater in the nepafenac group than in the vehicle group, although it was not statistically significant.65<\/span><\/p>\n There is an ongoing debate about cost-benefit ratio regarding prevention of PCMO.4<\/span>\u00a0PCMO treatment usually involves more invasive methods, which may cost more than prevention.69<\/span>\u00a0Schmier et al. found that patients who are treated for PCMO in the USA have higher Medicare claims than patients who do not develop PCMO. Of 78,949 patients who underwent cataract surgery, 2.54% (n=2,003) were diagnosed with PCMO. Ophthalmic charges were significantly higher for patients who developed PCMO (US $10,410 versus $5,950). Targeting interventions for high-risk patients are likely to be more cost-effective.70<\/span><\/p>\n Conclusions<\/p>\n Inflammation after cataract surgery remains an important cause of postoperative complications, such as intraoperative miosis, anterior uveitis, ocular hypertension or PCMO, even when using modern surgery methods. PCMO usually resolves spontaneously, although may cause a decrease in visual acuity and damage the macula when untreated. Postoperative inflammation of the eye can be relieved by steroids and\/or NSAIDs. These two classes of drugs have overlapping mechanisms of action. It is not yet verified if the interaction between these drugs is synergistic or additive. Based on the present accumulation of evidence the combination of steroids and NSAIDs in the perioperative period lead to benefits in visual acuity during 12 weeks after standard cataract surgery; however, this effect disappears after this period. On the other hand, combination therapy brings clear benefits in PCMO prevention in high-risk cataract cases in both short-term and long-term follow ups.<\/p>\n","protected":false},"excerpt":{"rendered":" Various options for the prevention of pseudophakic cystoid macular oedema (PCMO) have been offered. Nonsteroidal anti-inflammatory drugs (NSAIDs) seem to be beneficial in preventing postoperative inflammation; however, there is lack of evidence for long-term benefit after cataract surgery. What is more, topical NSAID preparations are difficult to compare, as studies differ in inclusion criteria, patient […]<\/p>\n","protected":false},"author":77775,"featured_media":17518,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","rank_math_lock_modified_date":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-17512","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","vocabulary_1-retina-vitreous"],"acf":[],"_links":{"self":[{"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/posts\/17512"}],"collection":[{"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/users\/77775"}],"replies":[{"embeddable":true,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/comments?post=17512"}],"version-history":[{"count":3,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/posts\/17512\/revisions"}],"predecessor-version":[{"id":17699,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/posts\/17512\/revisions\/17699"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/media\/17518"}],"wp:attachment":[{"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/media?parent=17512"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/categories?post=17512"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/touchophthalmology.com\/wp-json\/wp\/v2\/tags?post=17512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"http:\/\/touchophthalmology.com\/wp-content\/uploads\/sites\/16\/2019\/09\/Fig1-1-300x292.png\")
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\neffective in treatment of postoperative inflammation.51<\/span>\u00a0In a retrospective study, Tijunelis et al. reported no significant difference in IOP change between two groups of patients using difluprednate twice a day for 30 days and prednisolone acetate four times a day for 30 days after cataract surgery.50<\/span><\/p>\n![\"\"](\"http:\/\/touchophthalmology.com\/wp-content\/uploads\/sites\/16\/2019\/09\/Tab3-215x300.png\")
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