A 55-year-old woman undergoes phacoemulsification for age-related cataract. Postoperatively, she develops corneal edema and anterior chamber inflammation. Which is the drug of choice for reducing corneal edema and controlling postoperative inflammation?

Explanation

## Postoperative Anti-inflammatory Management After Cataract Surgery ### Prednisolone Acetate as First-Line Agent **Key Point:** Prednisolone acetate 1% is the drug of choice for postoperative inflammation and corneal edema following cataract surgery because of its superior corneal penetration and potent anti-inflammatory efficacy. ### Why Prednisolone Acetate is Superior **High-Yield:** Prednisolone acetate (suspension formulation) has significantly better corneal penetration than other corticosteroids due to its particle size and formulation, allowing higher intraocular concentrations without systemic absorption. **Mechanism of Action:** 1. Inhibits phospholipase A₂, reducing prostaglandin and leukotriene synthesis 2. Suppresses inflammatory cell migration and cytokine production 3. Reduces vascular permeability, decreasing corneal edema 4. Stabilizes blood-aqueous barrier ### Comparison of Postoperative Corticosteroids | Agent | Formulation | Corneal Penetration | Frequency | Potency | First-Line | |-------|-------------|-------------------|-----------|---------|------------| | **Prednisolone acetate 1%** | Suspension | **Excellent** | Every 2 hrs | Strong | **YES** | | Dexamethasone 0.1% | Solution | Good | Every 4 hrs | Very strong | No | | Betamethasone 0.1% | Solution | Moderate | Every 6 hrs | Strong | No | | Fluorometholone 0.1% | Suspension | Poor | Every 3 hrs | Mild | No | **Clinical Pearl:** Prednisolone acetate suspension must be shaken well before instillation to ensure uniform particle distribution. The suspension form (not solution) is critical for optimal corneal penetration. ### Postoperative Steroid Tapering Schedule 1. **Week 1–2:** Prednisolone acetate 1% every 2 hours (6 times daily) 2. **Week 3–4:** Every 4 hours (4 times daily) 3. **Week 5–6:** Every 6 hours (3 times daily) 4. **Week 7–8:** Twice daily 5. **Week 9+:** Once daily, then discontinue **Warning:** Abrupt discontinuation of corticosteroids can cause rebound inflammation. Gradual tapering is essential to prevent postoperative uveitis. ### Why Other Options Are Suboptimal - **Dexamethasone 0.1%:** Solution formulation with poorer corneal penetration; reserved for posterior segment inflammation - **Betamethasone 0.1%:** Less commonly used; inferior corneal penetration compared to prednisolone acetate - **Fluorometholone 0.1%:** Mild potency; poor corneal penetration; used only for mild allergic conjunctivitis, not postoperative cataract surgery inflammation **Mnemonic:** **PAC** = **P**rednisolone **A**cetate for **C**ataract surgery