Comparison of Efficacy between Non-Steroidal Anti-Inflammatory Drugs and Anti-Vascular Endothelial Growth Factor in Preventing Macular Edema after Cataract Surgery in Diabetic Patients.

Chia-An Hsu,Sheng-Chu Chi,Yu-Bai Chou

doi:10.3390/jpm12030351

Abstract

(1) Background: There is no consensus regarding the optimal strategy to prevent macular edema after cataract surgery in diabetic patients. The purpose of study is to compare the efficacy of topical nonsteroidal anti-inflammatory agents (NSAIDs) and intravitreal injections of anti-VEGFs for the prevention of macular edema after cataract surgery in diabetic patients without pre-existing macular edema. (2) Methods: A literature search of the MEDLINE, PUBMED, and EMBASE databases was conducted in July 2021. Studies involving either topical NSAIDs or intravitreal injections of anti-VEGF arms that reported either the occurrence of macular edema or changes in best corrected visual acuity (BCVA) were included. Weighted mean differences and risk ratios were calculated along with 95% confidence intervals. (3) Results: Intravitreal injection of anti-VEGFs provided short-term structural protection for one month in patients receiving cataract surgery, but the protective effect ceased to exist after three months. The structural protection of topical NSAIDs, however, can last for at least three months. Meanwhile, neither anti-VEGFs nor NSAIDs provided significant visual improvement. (4) Conclusions: Our study suggested that topical NSAIDs eye drops is an effective prevention strategy for macular edema after cataract surgery in diabetic patients.

Highlights

Macular edema that develop after cataract surgery in diabetic patients, including pseudophakic cystoid macular edema (PCME) and diabetic macular edema (DME), is one of the most common vision-threatening complications after uncomplicated cataract surgery in patients with diabetes [1]
Topical steroid was considered as the standard of care after cataract surgery in participating clinical trials, but it is yet inconclusive to determine the efficacy between NSAIDs eye drops and intravitreal anti-VEGF injection in preventing macular edema after cataract surgery after cataract surgery in diabetic patients
The risk ratio (RR: 2.31, 95% CI: 1.04~5.14) for macular edema at third month after cataract surgery was significantly higher in patients receiving antiVEGF injections compared to those receiving NSAIDs eye drops

Summary

Introduction

Macular edema that develop after cataract surgery in diabetic patients, including pseudophakic cystoid macular edema (PCME) and diabetic macular edema (DME), is one of the most common vision-threatening complications after uncomplicated cataract surgery in patients with diabetes [1]. The incidence of PCME without risk factors after uncomplicated cataract surgery ranges between 0.1% and 2.3%, and the peaks are at approximately 5 weeks in a healthy population. The incidence of PCME is significantly increased up to 16.3% in patients with previous DME or diabetic retinopathy, whose blood–retinal barrier has already been compromised before surgery [4]. These hypotheses explained their similarities in OCT features, but their relationship between PCME and DME in patients with diabetes. Previous literature showed that these two conditions could coexist [5,6]. It raises the level of difficulty for differentiation.

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