COMMENTARY

Cystoid Macular Edema Following Phacoemulsification

C. Robert Bernardino, MD

Disclosures

November 06, 2008

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.

Abstract

Comments

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