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Expert recommends 6 weeks of NSAIDs after cataract surgery in diabetic patients
Excerpted from dry eye, allergy, anti-inflammatory panel discussion at OSN New York 2010.
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 Eric D. Donnenfeld |
 Michael B. Raizman |
Case: A 78-year-old male physician presents with decreased vision and an 18-year history of orally controlled diabetes. Vision is 20/60, attributable to nuclear sclerotic cataract. Fundus reading reveals bilateral 1+ background diabetic retinopathy. Optical coherence tomography shows flat macula with no cystoid changes.
Eric D. Donnenfeld, MD: How do you manage this patient for cataract surgery pharmaceutically different from how you might manage another case?
Michael B. Raizman, MD: I routinely use nonsteroidals for 6 weeks in diabetics, even without retinopathy, but in this case absolutely, because of the presence of retinopathy. At 6 weeks, I routinely get an OCT to evaluate the macula. It is not uncommon to use nonsteroidals for 3 or 4 months after cataract surgery in these patients.
If there is absolutely no retinopathy, I still use the drops for 6 weeks. I might not use the nonsteroidals longer than that in those eyes. I have seen cases in which these patients get multifocal implants. That is a bad idea.
Dr. Donnenfeld: Is a preoperative OCT mandatory in a case like this?
Dr. Raizman: It depends on your rapport with the patient and how the patient feels about it. It is very important to talk to them about macular edema beforehand. This is not analogous to the way that I would get a preoperative OCT for a multifocal patient, for instance. I know this diabetic patient is going to have some macular swelling from the surgery, so I tell them in advance.
Dr. Donnenfeld: Ten years ago, we were not routinely using nonsteroidals on any of these patients. If there has been one tremendous advance in cataract surgery, it has not been phacoemulsification or lenses; it has been the routine use of nonsteroidals that has done more to improve the quality of vision.
Go to www.osnsupersite.com/view.aspx?rid=78672 to listen to the complete round table discussion.
- Eric D. Donnenfeld, MD, can be reached at Ophthalmic Consultants of Long Island, 2000 North Village Ave., Rockville Centre, NY 11570; 516-766-2519; email: eddoph@aol.com.
- Michael B. Raizman, MD, can be reached at New England Eye Center, Tufts University School of Medicine, 750 Washington St., Box 450, Boston, MA 02111; 617-636-4219; email: mraizman@tufts-nemc.org.
- Disclosure: No products or companies are mentioned that would require financial disclosure.