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Pre-phaco NSAIDs impede macular thickening and CME, surgeon says
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PHILADELPHIA — Preoperative treatment with nonsteroidal anti-inflammatory drugs can help prevent cystoid macular edema and improve quality of vision after phacoemulsification, according to a surgeon speaking here.
Calvin W. Roberts, MD, reviewed evidence-based studies that show the benefits of NSAIDs administered before and after cataract surgery at the 2007 Wills Eye Hospital Annual Alumni Conference. In particular, NSAIDs administered for 3 days before surgery lead to increases in intraoperative pupil size, while same-day NSAID dosing decreases intraoperative pupil size, he said.
Surgeons started using NSAIDs in 1991 to prevent intraoperative miosis, control normal postoperative inflammation and inhibit cyclooxygenase, Dr. Roberts said.
In a randomized study of 200 patients undergoing phacoemulsification, Dr. Roberts and colleagues found that macular thickness increased an average of 4.2 µm in patients treated with NSAIDs. In contrast, macular thickness increased an average of 10.4 µm among patients who did not receive NSAIDs preoperatively, he said.
NSAID-treated patients had a slightly lower mean visual acuity of 0.94 compared with 0.95 for those not treated with NSAIDs. However, NSAID-treated patients had better contrast sensitivities, Dr. Roberts noted.
Patients receiving NSAIDs were also more likely to have "excellent" macular function, he added.