Query
A complaint of foreign body sensation after a perfect clear corneal phaco, persisting up to 4-6 month after stopping all the medications is irritation both for the surgeon his patients. Aggravation of dry eye is said to be culprit. It was not with ECCE with IOL except initial 1-2 days, surely not for 4-6 month beyond topical treatment.
When I tried to analyse this, I discovered that foreign body sensation was a regular complaint (in 30-40 %) after I started using plain Prednislone for 5 weeks and plain Moxifloxacin for 1 week separately. So I decided to substitute Moxifloxacin with ofloxacin- the frequency of the complaint remained same. Then, keeping moxifloxacin constant, I replaced the prednisolone with Solodex (plain Dexamethasone). To my surprise, frequency of complaint of the foreign body sensation almost totally disappeared. When Solodex was discontinued recently, I started using combination of Ofloxacin + Dexamethasone for 5 week, keeping plain moxifloxacin constant for 1week. Even then I hardly came across the complaint of foreign body sensation.
I think prednisolone is culprit for symptoms even beyond discontinuation after 5 week. I think many of us must have used Dexona+ antibiotic combination previously must be using prednisolone antibiotic separately. Please share your retrospective analysis/ clinical impression.
Responses:
No:1
Dear Doctor,
Which brand are you using? Prednisolone acetate is a suspension, depending on the formulation there is a tendency for clumping of particles, which can cause FB sensation during its usage. I tried all formulations and zeroed in on Alconpred. The frequency of that problem reduced dramatically. Except for very few rare cases, which can be due to relative dry eye (Temporal Clear Corneal Incisison) or due to general tear film disturbance because of multiple medications.
Thanks,
No:2
Dear Doctor,
Thank you for posting on this very important finding. I came to a similar conclusion and do not use prednisolone eye drops. It is said that, in order to keep prednisolone in a suspension, the bottle contains millions of tiny glass beads and this may be the reason for this. Even I use ofloxacin + dexa combination and I never need to put post-op patients on refreshing tears!!!!!
with best wishes,
No:3
Congrats Doctor, for showing Chetna in keen clinical observation pearls! Thanks!! It’s not obscured by market drive in ophthalmology. Keep it up.
No:4
Dexamethasone is 4 times as potent as prednisolone, but has very poor penetration into A/C compared to Prednisolone (in phophate form). That is the reason majority of the surgeons are using it in place of beta dexamethasone.
Sorry it is Prednisolone Acetate. Infact Prednisolone Phosphate has far less penetration than dexamethasone (eg: Sofracort)
Thanks.
Dec 12, 2012 : The Good work Continues.