Successful treatment of cystoid macular edema with valdecoxib

Abstract

We would like to discuss a few points in the article about treating cystoid macular edema (CME) with valdecoxib by Reis et al.1 In this study, treatment outcome was measured by the best corrected visual acuity as well as by the reduction in clinically significant macular edema evaluated by slitlamp biomicroscopy. However, the authors mention that reduction in macular edema was hard to assess when evaluated by slitlamp biomicroscopy. It is recognized that an improvement in vision may reflect an ameliorating effect of treatment, which is not synonymous with elimination of the edema.2 To achieve a better relationship between visual improvement and the anatomical counterpart, we suggest the use of objective tools, such as fluorescein angiography, to evaluate the effectiveness of a CME treatment. With the use of fluorescein angiography, we can determine whether there is a decrease in leakage and pooling of fluorescein in the macular cystoid spaces or whether the angiographic CME persists despite an improvement in vision. Optical coherence tomography (OCT) may also provide a noninvasive, objective alternative to measure the central retinal thickness following treatment in pseudophakic CME.3 Finally, patients with clinically significant visual loss from macular edema after cataract surgery were consecutively enrolled in this cohort study. Active gastrointestinal, coronary artery, or hepatic diseases were ruled out. We would like to know whether patients with other systemic conditions such as diabetes mellitus, ocular diseases such as uveitis, or preexisting macular conditions were excluded in these consecutive cases to ensure that the pseudophakic macular edema was not related to other causes. This cohort study illustrates the apparent efficacy of valdecoxib in treating 10 patients with pseudophakic CME. However, spontaneous resolution of edema is possible even without treatment. In addition, the evidence of the effectiveness of nonsteroidal antiinflammatory drugs for both acute and chronic CME is inconclusive.4 We agree with Reis et al. that a prospective randomized clinical trial with a large sample size is important to determine the effectiveness of cyclooxygenase-2 (COX-2) inhibitors in the treatment of CME.