Preventing and treating cystoid macular oedema (CME) after cataract surgery
Topical nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent postoperative CME in patients undergoing cataract surgery
Cheryl Guttman Krader
Published: Thursday, July 20, 2017
Rudy Nuijts
Published: Thursday, July 20, 2017
Clinically significant CME affects between 0.1% and 2.4% of healthy eyes, but up to 31% of patients with diabetesCME TREATMENT Dr Wielders and colleagues also conducted a systematic review investigating the optimal pharmacological treatment of CME after cataract surgery. Again, the review excluded studies enrolling patients with any CME risk factors other than diabetes mellitus. Only 10 RCTs met the selection criteria, and many had small populations. Three studies showed that topical NSAIDs were more effective than placebo for improving CDVA and retinal morphology. Studies comparing different NSAIDs (ketorolac, diclofenac, bromfenac, nepafenac) found no significant difference between the medications. In two studies, results were better using an NSAID with a corticosteroid compared with a corticosteroid alone, but the differences were not statistically significant, perhaps due to small sample size. A few studies investigated alternate routes of administration. One study reported similar results in patients treated with a single sub-Tenon’s injection of triamcinolone versus a topical NSAID. Two placebo-controlled studies found no benefits of oral treatment with indomethacin or acetazolamide, although the results may reflect the very small sample sizes, Dr Wielders said. SEEKING DEFINITIVE EVIDENCE Dr Wielders noted that the systematic reviews have limitations stemming from the poor to moderate quality of some of the RCTs and the absence of consistent methodology and CME definitions. Thus, the PREMED study was undertaken by the ESCRS in order to develop evidence-based recommendations. It enrolled 914 patients without diabetes and 213 patients with diabetes at 12 European centres. Patients without diabetes were randomised to treatment with topical bromfenac, topical dexamethasone, or a combination of the two. Patients with diabetes were assigned to one of four groups to receive the topical combination regimen alone or with intravitreal bevacizumab (Avastin®, Genentech), subconjunctival triamcinolone, or both injections. The results will be presented at the XXXV Congress of the ESCRS in October. Preliminary analyses of postoperative mean central subfield macular thickness and CDVA, however, indicate there may be some between-treatment outcomes differences, Dr Wielders reported. Rudy Nuijts: rudy.nuijts@mumc.nl Jan Schouten: j.schouten@mumc.nl Laura Wielders: laura.wielders@mumc.nl
Tags: cataract, cystoid, macular, oedema, surgery
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