Inflammation-associated

postoperative pain results in dissatisfied patients by Sonia H. Yoo, MD The true impact of ocular inflammation on refractive cataract surgery outcomes Sonia H. Yoo, MD Reducing the impact of cataract surgical stress by mitigating inflammation and reducing ultrasound energy T he physical trauma associat-ed with ocular surgery can induce an inflammatory response that affects the entire eye. Inflammation on the cornea generates prostaglandins (caused by initiating the arachidon-ic acid cascade) that activate both cyclooxygenase-1 and cyclooxygen-ase-2.1 This cascade can manifest clinically as hyperemia, miosis, impaired vision, or diminished visual acuity secondary to cystoid macular edema (CME) in more severe cases.1,2 Subjective complaints can range from pain to photopho-bia.3 Phacoemulsification typically does not result in significant inflammation, but some patients are at higher risk and will experience some form of postoperative inflam-mation.4,5 For the typical cataract patient, what had been acceptable postop vision (20/40) years ago is no longer acceptable, especially in the premi-um IOL patient population.3 For this group, any postop incident that can reduce visual acuity (even if tran-sient) is considered a failure on the part of the surgeon to deliver the best care possible. Factors influencing postop inflammation The higher the density level of cataract, the greater the likelihood for inflammation6 (see Figure 1). Iris pigmentation is another factor; a primary reason anterior segment surgeons use NSAIDs postop is for CME prophylaxis. (See Table 2 for the list of recently approved NSAIDs and steroids.