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NSAIDs important in reducing retinal inflammation, treating macular edema, surgeon says
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DANA POINT, Calif. — Steroids are not as effective as nonsteroidal anti-inflammatory drugs in reducing prostaglandin synthesis and treating macular edema, according to a surgeon here.
"As retinal specialists, we use a lot of steroids [to treat patients]. As I started to prepare for this presentation, I realized how important NSAIDs are in reducing inflammation," David Boyer, MD, said during the Ocular Drug and Surgical Therapy Update meeting.
Macular edema is an accumulation of extravascular fluid in spaces within the inner nuclear and outer plexiform layer. If left untreated, it can lead to visual loss and loss of photoreceptors, he said.
"We know steroids partially inhibit [prostaglandin production], but they are not as effective as NSAIDs in reducing prostaglandin synthesis. So you must use much more topical corticosteroids to inhibit this prostaglandin production," Dr. Boyer said. Prostaglandins cause vasodilation, pupillary constriction and cystoid macular edema, he said.
"Currently, NSAIDS are used postoperatively, preoperatively, for allergic conjunctivitis and to reduce cystoid macular edema," Dr. Boyer said. "Systemic NSAIDs are not to be used. The side effects outweigh the potential benefits, and topical NSAIDS are all that is necessary.
"NSAIDS are more effective in reducing macular edema than steroids alone, but the combination appears to be superior to both," he said.
"If all else fails when you have edema, you can use anti-[vascular endothelial growth factor] drugs. In the future, you may even see NSAIDs as an adjunctive treatment for age-related macular degeneration because, experimentally, some of these may have an effect."