Prevention Of Cystoid Macular Edema Research Articles

Comparison of the efficacy and safety of non-steroidal anti-inflammatory drugs and corticosteroid drugs for prevention of cystoid macular edema after cataract surgery.

To compare the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAID), corticosteroid (CS), and a combination of both drugs to prevent cystoid macular edema (CME) after cataract surgery. We searched Pubmed, Cochrane Library, and Embase electronic databases to assess the relevant randomized controlled trials (RCTs) up to 28 April 2021. Network meta-analysis was registered on PROSPERO (CRD42020182520). Twenty-four RCTs were included in this review. The NSAID and combination of both drugs were significantly reduced the risk of developing CME than CS alone in non-diabetics and mix populations. In the ranking profiles, the combination therapy showed a significant advantage over the single drugs and was less likely to develop CME. Diclofenac was the most likely to reduce the odds of developing CME compared with bromfenac and nepafenac. Dexamethasone was the most likely to reduce the odds of developing CME compared with betamethasone and fluorometholone. NSAID combination with CS has significantly reduced the risk of developing CME postoperatively than the single drug. Diclofenac was superior to bromfenac and nepafenac in preventing CME. Dexamethasone was superior to betamethasone and fluorometholone in preventing CME.

Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6.

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema after cataract surgery in diabetic patients. 7 ophthalmology clinics in the Netherlands and Belgium. Prospective trial-based cost-effectiveness analysis using data from a European multicenter randomized clinical trial. Diabetic patients (n = 163) undergoing uneventful cataract surgery were randomized to perioperative subconjunctival triamcinolone acetonide (n = 36), perioperative intravitreal bevacizumab (n = 36), combination treatment (n = 45), or no additional treatment (control group, n = 46). The cost analysis was performed from a healthcare perspective within a 12-week postoperative time horizon. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER; cost per QALY). The mean total healthcare costs and QALYs were as follows: triamcinolone group €1827 (U.S. dollars [$] 2295)/0.166; bevacizumab group €2050 ($2575)/0.144; combination group €2027 ($2546)/0.166; and control group €2041 ($2564)/0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was €321 984 ($404 503) per QALY for the combination group compared with that of the triamcinolone group. Assuming the willingness-to-pay as €20 000 ($25 126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient who received triamcinolone developed clinically significant macular edema (CSME). A secondary cost-effectiveness analysis based on this outcome showed a clear preference for triamcinolone. In diabetic patients, subconjunctival triamcinolone was effective in preventing CSME after cataract surgery. The cost-effectiveness analysis showed that triamcinolone is also cost-effective.

A Comparison of Efficacy of Nepafenac 0.1% with Nepafenac 0.3% Drops for the Management of Post-Operative Inflammation and CME in Uneventful Phacoemulsification

Aim: To compare the efficacy of two topical nonsteroidal anti-inflammatory drops (NSAIDs) used in isolation in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. Design: Single armed randomized prospective study Methods: 200 patients who underwent uneventful phacoemulsification from December 2020 to March 2021 by a single surgeon were randomly assigned to be given one of the two NSAID drops. Among the 200 individuals those were included in the study, 192 patients completed follow up visits at 1 and 6 weeks and were included for analysis of the results. The efficacy of the drugs was evaluated by comparing the grade of pain score, conjunctival hyperemia, anterior chamber (AC) cells, along with best corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) recorded at 1 and 6 weeks after surgery. Results: Between the two NSAID groups, there was no significant difference in pain ratings, AC cell grade, or visual acuity. There was no significant difference in the number of patients experiencing CME at 6 weeks. At 1 and 6 weeks, however, the mean rise in central macular thickness and conjunctival hyperemia in nepafenac 0.3 percent was much smaller. Conclusion: The efficacy of both the topical NSAIDs was found to be comparable in terms of pain score, AC cells grade and visual acuity. Though occurrence of CME after surgery was similar in both the NSAID’s, subclinical CME was less in Nepafenac 0.3% group both at 1st and 6th week follow up. Keywords: non-steroidal anti-inflammatory drugs, visual acuity, central macular thickness, cystoid macular edema, phacoemulsification.

A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification.

Purpose:To compare the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification.Methods:All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti-inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative-free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery.Results:At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively).Conclusion:NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti-inflammatory agent in patients with uneventful phacoemulsification.

Anti-inflammatory Pharmacotherapy for the Prevention of Cystoid Macular Edema After Cataract Surgery

To elucidate strategies for and controversies surrounding the use of anti-inflammatory medications after uneventful cataract surgery, with a focus on the prevention of irreversible vision loss due to cystoid macular edema (CME). Perspective. Expert commentary on the management of inflammation after cataract surgery. Discussion includes combination therapy with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), dosing strategies, and emerging therapies. While prescribing both NSAIDs and corticosteroids for cataract surgery is common, these classes have overlapping mechanisms. Combination therapy may speed visual recovery, but there remains little evidence for improved long-term visual outcomes from NSAIDs. The last 2 decades have seen increasing data on potential benefits of pretreatment with NSAIDs 1-3 days prior to cataract surgery. Simultaneously, newly approved "dropless" delivery systems hold promise, and clinical trials are ongoing to assess outcomes of such formulations. Optimal pharmacologic treatment for inflammation after cataract surgery remains controversial. A consensus definition for clinically significant CME may facilitate the comparison of anti-inflammatory drugs. And there remains a need for well-designed trials examining both topical and extended-release drug-delivery systems to refine the treatment paradigm.

Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4.

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in patients without diabetes. Seven ophthalmology clinics in the Netherlands and Belgium. Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED). Patients without diabetes planned for expected uneventful cataract surgery were randomized to topical bromfenac (Yellox, n = 242), topical dexamethasone (n = 242), or a combination treatment (n = 238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY. The study comprised 722 patients without diabetes. Total healthcare costs and QALYs were € 447 (US $562) and 0.174 in the bromfenac group, €421 (US $529) and 0.179 in the dexamethasone group, and €442 (US $565) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was €6544 (US $8221) per QALY for the combination group compared with the dexamethasone group. Assuming that the willingness to pay is € 20 000 (US $25 126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively. In patients without diabetes, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery compared with treatment with either drug alone.

Steroidal versus non-steroidal eye drops in prevention of cystoid macular edema after cataract extraction in diabetic patients

Background: Cystoid macular edema (CME) is addressed as one of the most important complication responsible for suboptimal visual acuity outcome after cataract surgery. Objective: Comparison between topical steroids versus NSAIDs regarding ability to reduce CME after uneventful cataract surgery of foldable intraocular lens (IOL) implantation in diabetic patients. Patients and methods: In this study, 30 patients underwent phacoemulsification surgery with posterior chamber foldable intraocular lens implantation in Ophthalmology Department, Al-AzharUniversityHospital between December 2017 and November 2018. Patients were randomly categorized into 2 groups. Group 1: Nepafenac eye drops (0.1%) 3 times daily for one month, Group 2: Prednisolone eye drops (1%) 5 times daily for one month. Results: At the end of the follow up, foveal thickness changes in optical coherence tomography (OCT) were found to be slightly less in the no steroidal anti-inflammatory eye drops (NSAIDs) group than in the steroidal group with no significant change in the final visual outcome between the two groups. Conclusion: There was no significant statistical difference between NSAIDs drops and steroids drops in prevention of development of pseudophakic macular edema post cataract surgery.

Effect of 0.1% Bromfenac for Preventing Macular Edema after Cataract Surgery in Patients with Diabetes.

PurposeTo investigate the effect of 0.1% bromfenac sodium hydrate ophthalmic solution for prevention of macular edema after cataract surgery in patients with diabetes.MethodsA retrospective analysis of 75 patients with diabetes who underwent cataract surgery was performed. Thirty-eight patients (52 eyes) were instilled with 0.1% bromfenac solution (bromfenac group) and 37 patients (46 eyes) were not (control group).ResultsThere were no significant preoperative between-group differences. Compared to the control group, at 1 month after surgery, the bromfenac group showed slightly better best-corrected visual acuity (0.12 ± 0.12 vs. 0.32 ± 0.42, p = 0.142), lower central macular thickness (265.58 ± 31.28 vs. 314.15 ± 76.11 µm, p < 0.001), and lower macular volume (8.46 ± 0.60 vs. 9.14 ± 1.53 mm3, p = 0.022). There were no significant differences between the two groups at 4 and 6 months postoperatively (p > 0.05). Mean changes in central macular thickness showed significant differences at 1 and 4 months postoperatively (−1.44 ± 11.72 and 10.44 ± 22.48 µm in bromfenac group vs. 47.19 ± 70.24 and 31.69 ± 48.04 µm in control group, p < 0.001 and p = 0.016) and mean changes in macular volume showed a significant difference at 1 month postoperatively (−0.08 ± 0.47 mm3 in bromfenac group vs. 0.58 ± 1.28 mm3 in control group, p < 0.001). There were no significant differences thereafter (p > 0.05).ConclusionsTreatment with 0.1% bromfenac sodium hydrate ophthalmic solution showed good efficacy for preventing cystoid macular edema early after cataract surgery in patients with diabetes.

The role of perioperative nonsteroidal anti-inflammatory drugs use in cataract surgery

Purpose of review: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used and studied by cataract surgeons for varied benefits in the perioperative period. In this article, we perform a literature review of articles published between 1 January 2016 and 30 June 2018 concerning perioperative NSAID use for patients undergoing cataract surgery. Recent findings: Literature review revealed five areas of recent study including preoperative NSAID use for iatrogenic inflammation, intraoperative NSAID use for pupillary mydriasis, postoperative NSAID use for prevention of cystoid macular edema (CME), for prevention of pain/inflammation, and for improvement in patient quality of life. Summary: Recent literature establishes the efficacy of a newly available intracameral phenylephrine–NSAID combination for pupillary mydriasis, postoperative NSAID use for preventing CME in certain high-risk populations, and postoperative NSAIDs for controlling pain and inflammation. However, further high-quality studies are required to determine the long-term effects of perioperative NSAIDs on visual acuity and CME rates.

The role of perioperative nonsteroidal anti-inflammatory drugs use in cataract surgery.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used and studied by cataract surgeons for varied benefits in the perioperative period, but optimal medication formulae and dosing have yet to be established. In this article, we perform a literature review of articles published between 1 January 2016 and 30 June 2018 concerning perioperative NSAID use for patients undergoing cataract surgery. Literature review revealed five areas of recent study including preoperative NSAID use for iatrogenic inflammation, intraoperative NSAID use for pupillary mydriasis, postoperative NSAID use for prevention of cystoid macular edema (CME), for prevention of pain/inflammation, and for improvement in patient quality of life. Recent literature establishes the efficacy of a newly available intracameral phenylephrine-NSAID combination for pupillary mydriasis, postoperative NSAID use for preventing CME in certain high-risk populations, and postoperative NSAIDs for controlling pain and inflammation. However, further high-quality studies are required to determine the long-term effects of perioperative NSAIDs on visual acuity and CME rates.

Comparative study of the efficacy and safety of bromfenac, nepafenac and diclofenac sodium for the prevention of cystoid macular edema after phacoemulsification.

To compare the efficacy, tolerability and safety of bromfenac 0.09%, nepafenac 0.1% or diclofenac 0.1% for the prophylaxis of the cystoid macular edema (CME) after phacoemulsification. Group sequential observational comparative study. After phacoemulsification, patients received two months for topical treatment of either diclofenac sodium, bromfenac or nepafenac. All patients received concomitant topical tobramycin 0.3% and topical prednisolone 1%. We measured CME using optical coherence tomography (OCT) central foveal thickness, macular thickness and total macular volume. We enrolled 243 patients from January to June 2015, and 35% received diclofenac, 32.9% bromfenac and 32.1% nepafenac. When we compared pre-operative to three weeks to two months, bromfenac was more effective in reducing foveal volume (21.3 and 35.4 mm3, respectively), compared with the diclofenac (1.3 and 11.5 mm3, respectively), and the nepafenac group, became more edematous 6.4 and 5.3, respectively. Totally 133 patients completed the post-surgical satisfaction questionnaire. Patients complained of eye stickiness in 13.8% whom we gave nepafenac, versus 10.3% whom we gave diclofenac sodium, and in 0 whom we gave bromfenac. Bromfenac is the best tolerated and is more effective than diclofenac and nepafenac in reducing CME after phacoemulsification.

The Effectiveness Analysis of Joint Use of Different Groups Anti-Inflammatory Drugs Treatment and Prevention of Cystoid Macular Edema in Patients after Phacoemulsification

Purpose: to analyze the results of the joint eye drops application of 0.09 % solution of bromfenac and 0.1 % solution of dexamethasone and subtenons triamcinolone injection for treatment and prevention of cystoid macular edema (CME) in patients after phacoemulsification.Patients and methods: The study included 914 patients (1147 eyes) which held phacoemulsification with IOL implantation. Depending on the postoperative treatment patients randomized into two groups. Patients of the first group received instillation of eye drops of antibiotics-fluoroquinolones and 0.1 % dexamethasone. Patients of the second group were prescribed instillation of eye drops of 0.09 % solution of bromfenac in addition to the treatment. In each group the patients diagnosed CME after phacoemulsification were divided into subgroups depending on the presence or absence of concomitant involution of retinal pathology. In cases of diagnosis of macular edema after phacoemulsification (2nd group of patients) periocular triamcinolone injections were made.Results. The efficacy of bromfenac was estimated by the number of cases of postoperative CME in the compared groups. In patients of the first group, complications occurred in 3.1 % of cases. In patients of the second group the number of complications was significantly lower (1.5 %), including a significant reduction in the incidence of CME observed in patients without concomitant of macular pathology (AMD and epiretinal fibrosis). A combination of steroid and NSAID in the treatment of CME provides the regression of macular edema in all patients, regardless of the presence of involution macular pathology. The positive effect of periocular triamcinolone injections in the treatment of anti-inflammatory eye drops was noted in 8 of 9 cases a month after the first injection.

Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2

To compare the efficacy of perioperative treatment strategies, in addition to topical bromfenac 0.09% and dexamethasone 0.1%, to reduce the risk for developing cystoid macular edema (CME) after uneventful cataract surgery in diabetic patients. Twelve European study centers. Randomized clinical trial. Diabetic patients having phacoemulsification cataract surgery were randomly allocated to receive no additional treatment, a subconjunctival injection with 40mg triamcinolone acetonide, an intravitreal injection with 1.25mg bevacizumab, or a combination of both. The main outcomes were the difference in central subfield mean macular thickness, corrected distance visual acuity, and the incidence of CME and clinically significant macular edema within 6 and 12weeks postoperatively. The study comprised 213 patients. At 6 and 12weeks postoperatively, the central subfield mean macular thickness was 12.3μm and 9.7μm lower, respectively, in patients who received subconjunctival triamcinolone acetonide than patients who did not (P = .007 and P = .014, respectively). No patient who received subconjunctival triamcinolone acetonide developed CME. Intravitreal bevacizumab had no significant effect on macular thickness. Diabetic patients who received a subconjunctival injection with triamcinolone acetonide at the end of cataract surgery had a lower macular thickness and macular volume at 6 and 12weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.

European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1

To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. Twelve European study centers. Randomized clinical trial. Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6weeks and 12weeks postoperatively. This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3μm, 296.0μm, and 284.5μm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P=.006). The incidence of clinically significant macular edema within 12weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P=.043). Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug.

Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery.

PurposeTo determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME).SettingAmbulatory surgical center.MethodsProspective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests.ResultsMean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%).ConclusionsImmediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater.SynopsisImmediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.

Topical nonsteroidal anti-inflammatory drugs as adjuvant therapy in the prevention of macular edema after cataract surgery.

The purpose of the study was to assess adjuvant treatment with topical nonsteroidal anti-inflammatory drugs (NSAIDs) (0.9% bromfenac, 0.1% nepafenac, 0.5% indomethacin, or 0.1% diclofenac) in addition to topical steroidal treatment with 0.1% dexamethasone and 0.3% netilmicin for prevention of cystoid macular edema (CME) after uneventful small incision cataract extraction with foldable intraocular lens (IOL) implantation. Institute of Ophthalmology, Department of Scienze Mediche di Base, Neuroscienze ed Organi di Senso, Aldo Moro University, Policlinico Consorziale di Bari, Bari, Italy. A retrospective 6-month single center study. Patients were divided into groups according to treatment with topical drugs for 2weeks, after phacoemulsification with foldable IOL implantation. CME incidence was evaluated by assessing retinal foveal thickness changes using spectral domain optical coherence tomography. All patients were treated with a fixed combination of dexamethasone and netilmicin, and some patients were additionally treated with NSAIDs (bromfenac, nepafenac, indomethacin, or diclofenac). Fourteen patients were treated with bromfenac, 15 with nepafenac, 12 with indomethacin, and 14 with diclofenac; ten patients were treated with dexamethasone and netilmicin alone. At the end of the follow-up, macular thickness, evaluated at 1-week post-surgery, was reduced only in the group treated with nepafenac (-1.3%, p=0.048), was increased in the group treated with dexamethasone and netilmicin alone (+4.3%, p=0.04), and did not change in the groups treated with bromfenac (-1.1%, p=0.3), indomethacin (+0.1%, p=0.19), or diclofenac (+1.2%, p=0.74). There were no side effects in any group. Topical treatment with nepafenac, bromfenac, and indomethacin enhanced the efficacy of steroids to reduce postoperative macular edema. Diclofenac did not improve steroids efficacy.

Non steroidal anti-inflammatory drugs for preventing cystoid macular edema after cataract surgeries:a Meta-analysis

Non steroidal anti-inflammatory drugs for preventing cystoid macular edema after cataract surgeries:a Meta-analysis

Prevention of Cystoid Macular Edema After Cataract Surgery in Nondiabetic and Diabetic Patients: A Systematic Review and Meta-Analysis.

To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery. Systematic review and meta-analysis. setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs). RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabetic patients. Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria. Odds of developing CME within 3months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3months postoperatively, as compared to baseline. Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03-0.37) and mixed populations (OR 0.05; 95% CI 0.02-0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10-0.44) and diabetic patients (OR 0.17; 95% CI 0.05-0.50). Intravitreal corticosteroid or anti-vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects. Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic anddiabetic patients, as compared to topical corticosteroids.

Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study

PurposeTo compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction.MethodsPatients were assigned randomly to...

Non steroidal anti-inflammatory drugs in the prevention of cystoid macular edema after uneventful cataract surgery.

BackgroundCystoid macular edema (CME) remains an important complication after cataract surgery. There is no consensus about how to prevent this frequent complication. The purpose of this study was to conceive an effective anti-inflammatory strategy using nonsteroidal anti-inflammatory drugs (NSAIDs) together with regular treatment with corticosteroids to prevent CME and improve visual acuity after cataract surgery in patients without risk factors.Materials and methodsWe searched the PubMed, Cochrane, and Google Scholar databases focused on prospective, controlled, randomized, double-blind clinical trials published in the last 10 years, with a minimum follow-up of 4 weeks.ResultsA total of nine clinical trials, one systematic review, and two reviews satisfied our search criteria. Most studies highlighted that NSAIDs are as powerful as corticosteroids to diminish postoperative inflammation, and demonstrated an additional benefit when used in combination with standard corticosteroid postsurgical therapy. In addition, the use of NSAIDs in the perioperative period seems to significantly improve the outcome after surgery and helps prevent CME in low-risk patients.ConclusionThe prophylactic use of NSAIDs in combination with the standard postoperative steroid scheme appears to be a positive course of action for preventing CME after cataract surgery. We suggest a therapeutic scheme based on the administration of one drop four times a day, beginning the day before surgery and for 4 weeks after the procedure. It is also advisable to administer one drop every 15 minutes in the hour prior to surgery in order to obtain better anti-inflammatory efficacy.