Medical prophylaxis and treatment of cystoid macular oedema after cataract surgery
Sübutlu məlumatların xülasələri
11.05.2018 • Sonuncu dəyişiklik 11.05.2018
Editors
Prophylactic use of topical NSAIDs may be effective in the prevention of cystoid macular oedema (CMO) after cataract surgery compared with steroids. Topical NSAIDs might possibly be effective for the treatment of chronic CMO.
A systematic review
including 20 studies with a total of 3095 eyes was abstracted in DARE. Prophylactic intervention (NSAIDs) was effective in reducing the incidence of both angiographic (OR 0.36, 95% CI 0.28 to 0.45) and clinically relevant cystoid macular oedema (OR 0.49, 95% CI 0.33 to 0.73). There was also a significantly positive effect on improving visual acuity (OR 1.97, 95% CI 1.14 to 3.41). The results of the four trials testing medical therapy (NSAIDs, steroidal agents, acetazolamide, cycloplegic agents and hyperbaric
oxygen) for chronic CMO indicated a treatment benefit of improving visual acuity by two or more Snellen lines (OR 2.67, 95% CI 1.35 to 5.30).
A Cochrane review included 7 studies on the treatment of acute (3 studies) or chronic (4 studies) cystoid macular oedema (CMO), with a total of 266 subjects. In the studies examining chronic CMO, 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 was also found to be ineffective for chronic CMO in another small trial. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in
two trials. For the treatment of acute CMO with topical NSAIDs, the studies are too heterogeneous and small for conclusions.
Another Cochrane review included 34 studies involving over 5 000 participants assessing the prophylactic use of topical NSAIDs postoperatively. People receiving topical NSAIDs in combination with steroids compared with steroids alone may have a lower risk of poor vision due to CMO and lower risk of CMO at 3 months after cataract surgery (table ). Comparing NSAIDs alone with steroids, central retinal thickness was lower in the NSAIDs group at 3 months (mean difference MD -22.64 µm, 95% CI -38.86 to -6.43; 2 trials, 121 eyes). None of the studies comparing NSAIDs with steroids reported on poor vision due to CMO.
NSAIDs plus steroids compared with steroids for the prevention of macular oedema after cataract surgery
| Outcome | Relative effect
(95% CI) | Control - Risk with steroids | Intervention - Risk with NSAIDs plus steroids (95% CI) | № of participants
(studies) |
| Poor vision due to CMO at 3 months after surgery | RR 0.41
(0.23 to 0.76) | 74 / 1000 | 30 / 1000
(17 to 56) | 1360
(5) |
| CMO at 3 months after surgery,
assessed with OCT | RR 0.40 (CI 0.32 to 0.49) | 130 / 1000 | 52 / 1000 (42 to 64) | 3638
(21) |
Ədəbiyyat
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Rossetti L, Chaudhuri J, Dickersin K. Medical prophylaxis and treatment of cystoid macular edema after cataract surgery. The results of a meta-analysis. Ophthalmology 1998 Mar;105(3):397-405.
- Sivaprasad S, Bunce C, Patel N, Jyothi S. Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery. Cochrane Database Syst Rev 2005 Jan 25;(1):CD004239 [Last assessed as up-to-date: 5 August 2011]
- Lim BX, Lim CH, Lim DK et al. Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database Syst Rev 2016;(11):CD006683. .