Reducing

FLACS complications

Preoperative brimonidine reduces post-op conjunctival haemorrhage. Cheryl Guttman Krader reports

Asingle drop of brimonidine 0.15% instilled into the eye preoperatively significantly decreased the severity of subconjunctival haemorrhage after femtosecond laser-assisted cataract surgery (FLACS), reported Eric S Tam, MD, at the 2020 ASCRS Virtual Meeting.

“Subconjunctival haemorrhage is a common side-effect following FLACS. Brimonidine is a selective alpha-1 adrenergic agonist that lowers IOP and has a vasoconstrictive effect, and its preoperative use to reduce conjunctival haemorrhage has been studied for various ophthalmic procedures,” said Dr Tam, University of Toronto, Toronto, Canada.

“To our knowledge, this is the first study to evaluate the vasoconstrictive effect of brimonidine or any other agent for FLACS.”

The efficacy of brimonidine to reduce subconjunctival haemorrhage after femtosecond laser suction ring application was investigated in a prospective, masked study. Patients were randomised to receive the usual preoperative eye drops with or without one drop of brimonidine 0.15%. Dr Tam performed all surgeries using the samefemtosecond laser and phacoemulsification platform.

Subconjunctival haemorrhage was evaluated using images obtained prior to preoperative drop instillation and 15 minutes after surgery using the Oculus Keratograph M5. A Bulbar Redness Score (BRS) and Analyzed Area (AA) were recorded. Patients were excluded if they were on anticoagulation therapy, had prior conjunctival surgery, experienced an intraoperative complication, or if the Analyzed Area was less than 25 mm 2 or differed by more than 10% between preop and postop values.

The final analysis included 25 brimonidine-treated eyes and 37 control eyes. Mean BRS and mean AA values did not differ significantly between the two study groups preoperatively or postoperatively. There was also no statistically significant difference between groups in the mean change in AA from pre-op to post-op.

However, compared with the preoperative value, the mean BRS decreased postoperatively in the brimonidine group and increased postoperatively in the control group. The difference between groups for the mean change values was statistically significant (p=0.03).

Dr Tam acknowledged that it had a low sample size. There was also a trend towards a higher preoperative BRS in the study group (p=0.07). He also suggested that use of phenylephrine 10% for pupil dilation preoperatively may have partially masked the effects of brimonidine. Eric S Tam: es.tam@utoronto.ca

FREE 5 year membership for trainees

ESCRS

Membership

Reduced Registration Fees for ESCRS Congresses Subscription to Journal of Cataract & Refractive Surgery Access to ESCRS Grants, Bursaries and Research Awards

Access to:

ESCRS iLearn Online CME accredited interactive courses ESCRS On Demand Online library of presentations from ESCRS Congresses EUREQUO European Registry of Quality Outcomes for Cataract and Refractive Surgery ECCTR European Cornea and Cell Transplantation Registry