Introduction
Even in routine uncomplicated phacoemulsification, vision loss can occur due to postoperative cystoid macular edema (CME).[1] It is thought to be caused by intraocular inflammation causing accumulation of intraretinal fluid. Studies have demonstrated that topical nonsteroidal anti-inflammatory drugs (ketorolac) are effective at treating and preventing CME.[2] This study analyzed the combination of topical steroids plus ketorolac vs steroids alone in preventing postoperative CME in low-risk cataract patients.
A Randomized, Masked Comparison of Topical Ketorolac 0.4% Plus Steroid vs Steroid Alone in Low-Risk Cataract Surgery Patients
Wittpenn JR, Silverstein S, Heier J, Kenyon KR, Hunkeler JD, Earl M
Am J Ophthalmol. 2008;146:554-560
Summary
In this prospective study, subjects were randomized to receive either perioperative ketorolac 0.4% (3 days prior to surgery, as well as 4 doses every 15 minutes for 1 hour before surgery) plus postoperative prednisolone 1% or prednisolone alone. A total of 546 patients were enrolled and randomized to either the ketorolac/steroid group (n = 268) or steroid-only group (n = 278). Based on biomicroscopy, 5 cases of CME were identified in the steroid group, whereas none were seen in the ketorolac/steroid group. When using optical coherence tomography (OCT) imaging, the incidence increased to 6 for the steroid-alone group; the combination treatment group had no CME cases identified by OCT.
Comment
This study demonstrates that the addition of topical ketorolac prevents postoperative CME in low-risk cataract patients. Although the incidence of CME was low without pretreatment with ketorolac (6/278 or 2%), the vision loss from CME can be significant. The authors also noted that the cost to treat CME among Medicare patients was $3298; therefore, this addition to surgery may be quite cost effective.
Medscape Ophthalmology © 2008 Medscape
Cite this: Cystoid Macular Edema Following Phacoemulsification - Medscape - Nov 06, 2008.
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