Treatment Of Cystoid Macular Edema Research Articles

Intravitreal dexamethasone implant for treatment of persistent postoperative macular edema after vitrectomy

To date, there is no consensus about the management of persistent cystoid macular edema (CME) following vitrectomy. The aim of this study was to evaluate the efficacy and safety of intravitreal dexamethasone implants for the treatment of postoperative CME following vitrectomy. In this multicenter study we retrospectively reviewed the data of 24 patients (25 eyes) who had been treated with intravitreal dexamethasone (Ozurdex®) for the management of persistent postoperative CME following pars plana vitrectomy. The main outcome measure was central retinal thickness (CRT in µm) as assessed by spectral domain optical coherence tomography (SD-OCT). Secondary outcome measures included change in best corrected visual acuity (BCVA) and the presence of metamorphopsia. All 19 eyes which were postoperatively examined within 4-8 weeks after implantation showed a significant decrease in CRT (mean 564µm to 315µm) and a reduction of metamorphopsias. Within the same period of time the BCVA improved in 15 out of 19 eyes (79%) which corresponds to an average visual improvement from 0.69logMAR to 0.46logMAR (P<0.0001). In eyes examined after 10-16 weeks a slight increase in the average CRT of 351µm was observed, whereas the BCVA improved to 0.28logMAR. After 4 months a decrease in average BCVA was noted. Out of 25 eyes 12 required further dexamethasone implantations between 1 and 4 times within the investigation period. The first repeat injections were performed an average of 7.3 months after the initial treatment. Our results suggest that intravitreal dexamethasone is a safe and effective treatment option for persistent CME following vitrectomy.

Comparison of intravitreal bevacizumab with intravitreal triamcinolone acetonide for treatment of cystoid macular edema secondary to retinal vein occlusion: a Meta-analysis.

To compare the effects of intravitreal injection of bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVTA) on the treatment of cystoid macular edema (CME) secondary to retinal vein occlusion (RVO). A literature search was conducted using PubMed, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. The comparison was divided into two groups, group 1 conducted comparison in branch RVO (BRVO) or central RVO (CRVO), group 2 conducted comparison in ischemic-RVO or nonischemic-RVO. Pooled mean differences (MDs) for changes in visual acuity (VA), central macular thickness (CMT) and intraocular pressure (IOP) were calculated in groups at 4, 12 and 24wk after treatment respectively. Eight studies comparing the efficacy of IVB with IVTA were included in the Meta-analysis. In group 1, in BRVO, significant difference was shown on the comparison of CMT at 24wk (MD, -45.66; 95% CI, -76.03 to -15.28; P=0.003), IVB was effective on BRVO for at least 24wk; no significant differences were found in the comparison of VA at each time points (P>0.05 respectively). In CRVO, no significant differences were found in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). In group 2, in ischemic-RVO, significant differences were shown in the comparison of VA (MD, -0.28; 95% CI, -0.42 to -0.14; P<0.0001) and CMT (MD, -86.50; 95% CI, -151.18 to -22.43; P=0.008) at 24wk; In nonischemic-RVO, no significant differences were demonstrated in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). The occurrence of high IOP was much lower in IVB group. This Meta-analysis suggested that IVB was effective in decreasing CMT in BRVO for at least 24wk, IVB is more effective on improving VA and reducing CMT in ischemic-RVO. IVB is more promising on RVO than IVTA.

Strong topical steroid, NSAID, and carbonic anhydrase inhibitor cocktail for treatment of cystoid macular edema.

PurposeTo report the combination cocktail of strong steroid, non-steroidal anti-inflammatory drug (NSAID), and carbonic anhydrase inhibitor drops for treatment of cystoid macular edema.MethodsThis is a retrospective case series of patients with cystoid macular edema managed with a topical combination of strong steroid (difluprednate), NSAID, and carbonic anhydrase inhibitor drops. The patients were followed with optical coherence tomography and fluorescein angiography.ResultsIn our six cases, resolution of the cystic edema with improvement in visual acuity was achieved with the use of a combination cocktail of drops. Leakage on fluorescein angiography and cystic edema on optical coherence tomography both responded to treatment with the topical cocktail of drops.ConclusionA topical cocktail of strong steroid, NSAID, and carbonic anhydrase inhibitor drops are effective for managing cystoid macular edema. Further studies comparing this combination with more invasive treatments should be undertaken to determine the efficacy of this cocktail over other treatment options.

Effect of interferon α2a in cystoid macular edema due to intraocular infection.

Cystoid macular edema (CME) is a severe complication and a major cause of visual loss in patients with intraocular infection. In this type of CME, therapeutic strategies remain controversial. We aimed to investigate the efficacy and tolerability of interferon (IFN)-α2a in cystoid macular edema caused by intraocular infection. In this retrospective, noncomparative, interventional case series, 5 patients (6 eyes) who were diagnosed with intraocular infection with chronic CME were included. Interferon-α2a (3 million units 3 times a week) was administered subcutaneously. Clinical observations were recorded before and after treatment. The average duration of CME before treatment with IFN-α was 26 months. According to the preset criteria, IFN-α2a therapy was shown to be effective in 2 patients (3 eyes), effective dose-dependent in 2 patients, and partly effective in 1 patient, and was well-tolerated in 4 patients. The most common side effect was flu-like symptoms. Interferon α-2a may be an effective alternative treatment for CME due to intraocular infection that is resistant to other treatment. Studies with larger sample sizes are required to confirm this conclusion.

Intravitreal bevacizumab and triamcinolone for treatment of cystoid macular oedema associated with chronic myeloid leukaemia and imatinib therapy.

Purpose. To evaluate the efficacy of intravitreal bevacizumab and triamcinolone in the treatment of cystoid macular oedema in a case with chronic myeloid leukaemia on imatinib treatment. Methods. We treated a 78-year-old man with bilateral cystoid macular oedema with intravitreal triamcinolone and subsequent bevacizumab in one eye and intravitreal bevacizumab, alone, in the fellow eye. Results. Serial intravitreal bevacizumab with and without triamcinolone treated cystoid macular oedema in both eyes and improved the vision. Conclusion. Intravitreal bevacizumab and triamcinolone could be viable options to treat cystoid macular oedema due to chronic myeloid leukaemia and imatinib therapy.

Prophylaxis and treatment of cystoid macular edema after cataract surgery

O edema macular cistoide e uma das principais causas de baixa de visao apos cirurgia de catarata. O processo inflamatorio parece ser o principal fator causal do edema. Sao considerados fatores de risco complicacoes cirurgicas, doencas retinianas previas, diabetes, uveites e uso de colirios de prostaglandinas. O diagnostico e feito clinicamente, mas a angiografia fluoresceinica e a tomografia de coerencia optica tambem sao ferramentas importantes para detectar o edema e auxiliar no diagnostico diferencial. Apesar da profilaxia pre-operatoria nao ter evidencia cientifica, ela e preconizada especialmente nos casos com fatores de risco. O tratamento inicial e realizado com associacao de corticoide e anti-inflamatorio nao hormonais topicos. Os casos cronicos e refratarios tem diversas alternativas de tratamento, sendo o uso de triancinolona e antiangiogenicos intravitreos as mais utilizadas. Este artigo se propoe a discutir diversos aspectos do edema macular cistoide pseudofacico.

A Novel Avastin Injection Technique—“Sunalp Protocol”

Purpose: The introduction of vascular endothelial growth factor (VEGF) inhibitors began a new era in the treatment of exudative age-related macular degeneration (ARMD). These drugs are effective at suppressing choroidal neovascularization (CNV) resulting in improvement or stabilization of visual acuity; however, the chronic nature of the disease require these drugs be administered periodically (usually monthly) for the life of the patient. Since intravitreal injections are administered through the sclera, there is the possibility of adverse events, such as vitreous hemorrhage, endophthalmitis, retinal tears, or retinal detachment. To avoid some of the adverse events associated with intravitreal delivery via the scleral route we have developed a technique to deliver bevacizumab (Avastin®) into the vitreous cavity in pseudophakic eyes via a corneal route.Methods: A 27-gauge, 5 mm angled cannula attached to a 1.0 ml syringe is fitted into an 11 o’clock limbal incision and advanced through the anterior and posterior chamber. The cannula is maneuvered through the zonules into the vitreous and 0.1 ml of Avastin is delivered behind the lens into the vitreous cavity. The procedure was performed in 50 eyes (Addendum 1: 499 injections 2014–2015), of five exudative ARMD patients, 21 diabetic macular edema (DME) patients, two cystoid macular edema (CME) patients, and one central retinal vein occlusion (CRVO) patient. Visual acuity (VA), edema, optical coherence tomography (OCT), and endothelial cell counts were performed 1 day following Avastin administration. VA was also determined in 16 eyes at 1 month after Avastin administration.Results: At 1 day post-Avastin administration, vision acuity and edema index improved or remained stable in all eyes, with the exception of one eye from an exudative ARMD patient whose vision deteriorated. At 1 month the average visual acuity in 16 eyes was also significantly improved. The improvement in edema was evident through retinal OCTs. No change in endothelial cell counts was observed.Conclusions: Administration of Avastin via an anterior chamber route in pseudophakic (Addendum 2: Phakic eyes were also treated with no cataract formation) patients is effective for the treatment of exudative ARMD, DME, CME and CRVO, minimizing the possible adverse events related to the administration by the traditional scleral route. In addition, anterior segment administration allows the ophthalmologist to directly observe the delivery of the drug with microscope precision. Pars plana injections are usually performed without magnification and no direct visualization.

Comparison of Topical Dorzolamide and Ketorolac Treatment for Cystoid Macular Edema in Retinitis Pigmentosa and Usher's Syndrome

Purpose: To investigate the topical effect of dorzolamide versus ketorolac on retinitis pigmentosa (RP) and Usher's syndrome (US) macular edema. Methods: Prospective, randomized and interventional study. A total of 28 eyes of 18 patients were included. Five eyes had US, 23 had RP. Fifteen eyes were allocated to ketorolac tromethamine 0.5% (4 drops daily regimen) and 13 eyes to dorzolamide hydrochloride 2% (3 drops daily regimen) treatment groups. Snellen's best-corrected visual acuity (BCVA), foveal thickness (FT) and foveal zone thickness (FZT) measured by Stratus® optical coherence tomography (OCT) were evaluated at baseline, 1, 3, 6 and 12 months after treatment. Results: Patients assigned to ketorolac had a baseline BCVA of 0.37 ± 0.17 logMAR which improved at the end of 1 year to 0.28 ± 0.16 (p = 0.02). Three eyes (20%) of 2 patients improved by 7 letters or more. Mean FT and FZT did not change significantly during the study follow-up. After 1 year of treatment, 4 eyes (27%) of 3 patients showed an improvement of at least 16% of FT and 11% of FZT. Patients assigned to dorzolamide had a baseline BCVA of 0.48 ± 0.34 logMAR which improved in the first 6 months (0.40 ± 0.30; p = 0.01), with a decrease at 1 year (0.42 ± 0.27; p = 0.20). Seven eyes (54%) of 5 patients had an improvement of 7 letters or more. Mean FT and FZT did not change significantly either. After 1 year of treatment, 3 eyes (23%) of 2 patients showed an improvement of at least 16% on FT and 11% on FZT. Conclusions: Results suggest that dorzolamide and ketorolac might improve visual acuity and therefore be of interest in selected cases. No relationship between retinal thickness fluctuation and visual acuity was found. Sample size was a limitation to the study.

Topical dexamethasone–cyclodextrin microparticle eye drops for uveitic macular oedema

Cystoid macular oedema (CME) is the main cause of visual loss in patients with uveitis (Rothova 2007). The mainstay of treatment of uveitic CME is corticosteroids and to be effective, steroid needs to be given periocularly, intravitreally or systemically. Topical steroid generally is of little benefit for the treatment of posterior segment diseases. Dexamethasone eye drops containing γ-cyclodextrin-based nanoparticles, however, have recently been shown to be effectively delivered to the posterior part of the eye to treat diabetic CME (Loftsson & Stefánsson 2002; Loftsson et al. 2007; Tanito et al. 2011). Therefore, it seems tempting to examine the effect of this dexamethasone eye drop formulation for the treatment of uveitis with posterior manifestations. We have treated three patients with uveitic CME with 1.5% dexamethasone–cyclodextrin ophthalmic solution (Oculis ehf., Reykjavik, Iceland) after obtaining informed consent from each patient. A 54-year-old female with bilateral, chronic, idiopathic intermediate uveitis and CME. Left eye was previously vitrectomized. Visual acuity was reduced to 0.4 (in decimals) on both eyes. She had pronounced CME and slight vitritis (+1) in both eyes. The CME and vitritis resolved on treatment with systemic prednisone in high dose and visual acuity increased to 0.63 in both eyes. CME on the left eye, however, recurred 3 months after tapering prednisone (Fig. 1A), and visual acuity dropped down to 0.5. The patient was then treated with 1.5% dexamethasone–cyclodextrin ophthalmic solution four times daily for 1 month in the left eye. Visual acuity increased to 0.63 and the CME resolved (Fig. 1B). As dexamethasone–cyclodextrin eye drops are not available in Denmark, she then continued treatment with commercial dexamethasone eye drops, Maxidex ® (Dexamethasone 0.1%; Alcon Inc, Fort Worth, TX, USA) 4 times daily in the left eye. After 1 month, the CME in the left eye had recurred (Fig. 1C), and she was subsequently treated with periocular triamcinolone acetonide and systemic prednisone in a low dose. A 84-year-old woman with bilateral vitritis and CME. Vitritis resolved after initating systemical treatment with mycophenolate mofetil. CME was persistent in both eyes (foveal thickness 357/332 μm). Visual acuity was 0.5 in both eyes. Right eye was treated with dexamethasone–cyclodextrin eye drops two drops four times daily tapered to one drop three times daily after 3 weeks. Left eye was treated with an intravitreal dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, CA, USA). After 6 weeks of treatment, visual acuity was 0.8 in the right eye and 0.63 in the left eye, and the CME had resolved in both eyes (foveal thickness 315/317 μm). A 47-year-old woman with chronic, bilateral, posterior uveitis and CME. She was treated with Ozurdex in both eyes, but the CME recurred after 3 months. The Ozurdex implantation was repeated on the left eye. The right eye was treated with dexamethasone–cyclodextrin eye drops one drop six times daily for 1 week and then four times daily for 1 week. After 2 weeks of treatment, the CME in the right eye was increased further, and the eye received a new Ozurdex implant. The present cases indicate that topical dexamethasone–cyclodextrin nanoparticle eye drops may be effective for the treatment of uveitic CME in some patients. In the first two cases, the CME was resolved after 1 month of treatment with this topical steroid formulation and recurred 1 month after treatment with conventional steroid eye drops. It therefore seems worth to explore the potential of dexamethasone–cyclodextrin nanoparticle eye drops for the treatment of uveitis with posterior manifestations as an alternative to periocular, intravitreal and systemic treatment with steroid. Periocular and intravitreal steroid carry a potential risk of ocular complications, and treatment with systemic steroid involves a considerable risk of serious systemic side-effects. Moreover, in children, the possibility of topical steroid treatment for uveitis with posterior manifestations would be of great benefit as treatment with periocular and intravitreal steroid in these patients requires a general anaesthetic prior to administration.

Cystoid macular edema after epiretinal membrane surgery: Incidence, risk factors and evolution with treatments

AbstractPurpose To report the incidence, the risk factors and the evolution after treatment of cystoid macular edema (CME) complicating epiretinal membrane (ERM) surgery.Methods This study included 647 consecutive patients with ERM operated by 23‐gauge parsplana vitrectomy between January 2011 and July 2013. Combined phacoemulsification of the lens was performed in 71% of cases. Patients were considered as having a CME if they presented augmentation of central macular thickness with presence of cysts on OCT scans in the first year after surgery. Patients with history of retinal detachment, vein occlusion, uveitis, diabetic macular edema or neovascular AMD were excluded.Results The incidence of CME was 2.6% (16/605) occurring within an average time of 129 ± 101 days. Predictive factors were the presence of preoperative CME on OCT scans (p=0.04) and preoperative prostaglandin use (p=0.02). Combined phacoemulsification was not identified as a risk factor. Treatment consisted in topical applications of non‐steroidal anti‐inflammatory drugs (NSAIDs) associated with dexamethasone and/or acetazolamide for a mean duration of 4 months. Intravitreal or subconjonctival corticoids injections were performed in 6 patients. A two‐line or more improvement in visual acuity was achieved respectively in 6 of 14 (43%) and 4 of 6 patients (67%). A dissipation of cysts on OCT scans was observed respectively in 4 of 14 (29%) and in 5 of 6 patients (83%).Conclusion The incidence of CME after ERM surgery was 2.6%. Preoperative prostaglandin use and preoperative CME were associated with an increased risk of postoperative CME. Treatment with NSAIDs was effective in about one third of patients, corticoids injections in 5 of 6 patients.

Intravitreal ranibizumab for the treatment of irvine‐gass syndrome

AbstractPurpose The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME).Methods This retrospective study comprised seven eyes with CME treated with intravitreal ranibizumab. Patients were examined at one week, one month after injection and monthly thereafter. Main outcome measures included changes in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects.Results There was a statistically significant difference on BCVA (p&lt;0.001) and CRT (p&lt;0.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in one patient, in a long‐term follow‐up. No observable ocular or systemic side‐effects were found.Conclusion Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.

Intravitreal Dexamethasone Implant in Patients with Persistent Macular Edema of Variable Etiologies

Purpose: To examine the effect of an intravitreal dexamethasone drug delivery system (DEX-DDS) in the treatment of persistent cystoid macular edema (CME) of different etiologies. Methods: Thirty-seven eyes with persistent CME were treated with DEX-DDS and analyzed for changes in best-corrected visual acuity (BCVA) and optical coherence tomography. Eyes were categorized into three groups: diabetic macular edema (DME, n = 14), vein occlusion (n = 15) and uveitis (n = 7). Results: The mean follow-up was 22 ± 6.9 weeks. BCVA improved from 0.62 ± 0.38 to 0.35 ± 0.29 logMAR (p < 0.0001). Central macular thickness decreased by 184 ± 246 µm from baseline (p < 0.0001). In eyes where CME resolved and recurred, the average CME-free period was 11 weeks. The uveitis group showed faster CME resolution (2 weeks) and a longer CME-free period (20 weeks). Similar efficacy was shown for repeat DEX-DDS injections. The safety profile was good. Conclusion: DEX-DDS is beneficial in the treatment of persistent CME. In cases of uveitis, CME resolution is rapid, resulting in the longest effect duration, when compared with other CME etiologies.

Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome

Purpose: The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME).Methods: This retrospective study comprised 7 eyes with CME treated with intravitreal ranibizumab. Patients were examined at 1 week and 1 month after injection and monthly thereafter. Main outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects.Results: There was a statistically significant difference on BCVA (p < 0.001) and CRT (p < 0.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in 1 patient, in a long-term follow-up. No observable ocular or systemic side effects were found.Conclusions: Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.

Clinical observation of retrobulbar injection of triamcinolone acetonide combined 577nm laser macular grid photocoagulation for the treatment of cystoid macular edema

Clinical observation of retrobulbar injection of triamcinolone acetonide combined 577nm laser macular grid photocoagulation for the treatment of cystoid macular edema

Successful treatment of the Irvine-Gass syndrome with Nevanac

The Authors describe a clinical case of the use of Nevanac - a medication from NSAID group in the successful treatment of cystoid macular edema caused by cataract extraction (Irvine-Gass syndrome).

Anterior vitreous displacement of the intravitreal dexamethasone implant (Ozurdex)

Sir, Ozurdex is a biocompatible implant licensed for the treatment of cystoid macular oedema (CMO) after retinal vein occlusions. We report a case of anterior vitreous displacement of Ozurdex, discussing the possible mechanism and outcomes of it.

Therapeutic effect of prolonged treatment with topical dorzolamide for cystoid macular oedema in patients with retinitis pigmentosa

AimTo evaluate the therapeutic effect of continuous treatment with topical dorzolamide (a carbonic anhydrase inhibitor) for cystoid macular oedema (CME) associated with retinitis pigmentosa (RP).Methods18 eyes in 10 patients with...

Non diabetic CME

AbstractPurpose Cystoid macular edema (CME) occurs in a variety of pathological conditions beside diabetic retinopathy, such as retinal vein occlusion, pseudophakia, penetrating ocular injury and uveitis. CME is a major cause of vision loss following cataract and vitreoretinal surgery. This presentation overviews the major developments in the treatment of CME, and the contribution of recent clinical trials to the understanding of the pathophysiology and factors that play a role in non‐diabetic CME and outcomes of treatment, as well as the problems that remain to be solved by both the basic and clinical researchers.Methods Differential diagnosis is essential for management and distinction between diabetic, age‐related macular degeneration, and other causes of CME. Pseudophakic CME is characterized by poor visual acuity following surgery. Clinically significant CME generally develops 4‐12 weeks after surgery. The workup of CME is performed with fluorescein angiography and optical coherence tomography. While pseudophakic CME can resolve spontaneously, some cases of CME require treatment.Refined surgical techniques contribute to reducing the incidence of CME. Intraoperative complications may elevate the risk of developing postoperative CME.Results Peri‐ or intraocular corticosteroids can be useful in persistent cases. Topical non‐steroidal anti‐inflammatory drugs (NSAIDs) and corticosteroids show the highest success rate for post‐surgical CME.Conclusion While the etiology of CME remains to be elucidated, the recent years have been the framework of major advances in treatment of CME. The response to antiangiogenic treatment is currently under evaluation, with some reported improvements from bevacizumab monotherapy, and combination therapies with NSAIDs and corticosteroids. Surgical treatment is considered in severe case. Commercial interest

Intravitreal Ranibizumab for the Treatment of Cystoid Macular Edema in Irvine-Gass Syndrome

To evaluate the functional and anatomical outcome after intravitreal ranibizumab injection in 2 patients with cystoid macular edema (CME) related to Irvine-Gass syndrome. Two patients with pseudophakic CME refractory to current standard topical treatment were enrolled in this study. Intravitreal (0.5 mg/0.05 mL) ranibizumab injection was performed. Baseline visits included best-corrected visual acuity (BCVA), a fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FA). The main outcome measures were changes in visual acuity, retinal thickness on OCT, and complications related to treatment. FA and OCT confirmed the diagnosis of pseudophakic CME in both cases. The initial BCVA was 5/100 in the first case. After 1 injection of intravitreal ranibizumab, retinal edema totally regressed and BCVA improved to 6/10. The central macular thickness (CMT) measured with OCT was 379 μm at baseline and decreased to 227 μm at the 16-month visit. The initial BCVA was 5/10 in the second case. It improved to 8/10 after 2 ranibizumab injections and remained unchanged at the 21-month visit. The CMT measured with OCT was 419 μm at baseline and decreased to 243 μm at the final follow-up. There were no ocular or systemic complications related to the intravitreal injections. Intravitreal ranibizumab appeared to be an effective treatment of macular edema related to Irvine-Gass syndrome. Prospective controlled studies are warranted to compare the long-term safety and efficacy between intravitreal ranibizumab and other treatment options in cases of Irvine-Gass syndrome.

Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery.

Cystoid macular oedema (CMO) is the accumulation of fluid in the central retina (the macula) due to leakage from dilated capillaries. It is the most common cause of poor visual outcome following cataract surgery. The exact cause is unclear. Acute CMO, defined as oedema of less than four months duration, often resolve spontaneously. CMO that persists for four months or more is termed chronic CMO. Different types of non-steroidal anti-inflammatory agents (NSAIDs) are used in the treatment of CMO which may be delivered topically or systemically. To examine the effectiveness of NSAIDs in the treatment of CMO following cataract surgery. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 7), MEDLINE (January 1950 to August 2011), EMBASE (January 1980 to August 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to August 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (August 2011) and ClinicalTrials.gov (www.clinicaltrials.gov) (August 2011). We searched the reference lists of identified trials. We searched conference abstracts (sessions related to cataract) in The Association for Research in Vision and Ophthalmology (ARVO) 1975 to 2011. We contacted experts in the field and NSAIDs manufacturers for details on published and unpublished trials.There were no language or date restrictions in the search for trials. The electronic databases were last searched on 5 August 2011. We included randomised controlled trials evaluating the effects of NSAIDs in the treatment of CMO following cataract surgery. Two review authors independently extracted data. Since considerable heterogeneity was observed between studies we did not conduct meta-analyses. Seven trials involving a total of 266 participants were included. Four trials studied the effects of NSAIDs in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. Of the studies examining chronic CMO, one study enrolled 120 participants, but the remainder had 34 or fewer participants. Four different NSAIDs were used and administered in different ways. Indomethacin was used orally and was found to be ineffective for chronic CMO in one trial. Topical fenoprofen appeared effective but not statistically significantly so for chronic CMO in another small trial. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. Three trials examined the effect of topical NSAIDs on acute CMO. The comparisons among these studies were of an NSAID to placebo, prednisolone or another NSAID. The study design differed between the studies in other important aspects thus they could not be combined in a meta-analysis. This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO and two trials which revealed no significant difference between comparative groups. As such, the effects of NSAIDs in acute and chronic CMO remain unclear and needs further investigation.