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Surgeon: Use NSAID preoperatively to minimize CME after cataract surgery

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Calvin W. Roberts, MD, told attendees at The Royal Hawaiian Eye Meeting preop use of NSAIDs can help preserve macular function in cataract patients.

WAIKOLOA, Hawaii — Preoperative use of a nonsteroidal anti-inflammatory drug can help preserve macular function and reduce the incidence of cystoid macular edema in cataract patients, said Calvin W. Roberts, MD.

Cataract surgery can trigger inflammation throughout the eye, Dr. Roberts said here at Hawaii 2005, The Royal Hawaiian Eye Meeting. He described a study he conducted with colleagues, in which patients who were given an NSAID for the three days prior to surgery had less swelling than patients not given an NSAID. The researchers found no correlation between macular swelling and visual acuity in the study, but they did find a correlation between macular thickness and contrast sensitivity.

“We found that contrast sensitivity was a much better way to evaluate if there was macular swelling. Today we are redefining CME to mean any decrease in visual function as a result of macular edema,” Dr. Roberts said.

He recommended beginning a treatment regimen 3 days before cataract surgery with Acular LS (ketorolac tromethamine ophthalmic solution 0.5%, Allergan) and Zymar (gatifloxacin, Allergan), each four times daily. Beginning 1 hour before surgery, he said, the patient should be treated with Acular LS, Zymar, phenylephrine 2.5% and tropicamide 1%.

Postoperatively, the patient should receive Zymar, Pred Forte (prednisolone acetate, Allergan) and Acular LS, first in the recovery room, and then four times a day for 1 week.

“After 1 week, assuming there is minimum inflammation, stop the steroids, but continue with the NSAIDs to prevent CME by controlling the development of prostaglandins,” Dr. Roberts said.