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Incidence of cystoid macular edema lowered with prophylaxis, topical steroids
Following phacoemulsification, the incidence of cystoid macular edema may be reduced with prophylaxis and the use of topical steroidal and nonsteroidal agents, according to a study.
The retrospective review included 2,862 phacoemulsification procedures performed over a 5 year period.
Acute postoperative cystoid macular edema (CME) was confirmed in 3 cases (0.1%) within the 3 month postoperative period. Topical prophylaxis with prednisolone acetate and ketorolac tromethamine 0.4% was started 1 day postoperatively for diabetic patients and patients implanted with an anterior chamber IOL.
Of the three patients with CME, one had a history of diabetic retinopathy; the other two patients were implanted with a posterior chamber IOL due to uneventful phacoemulsification, and one of these patients was further implanted with anterior chamber IOL due to damage to the capsule.
“Although not a randomized prospective study, we believe this finding will help substantiate the widely held view that topical steroidal and nonsteroidal agents help reduce the frequency of CME,” the study authors said. “If the incidence of CME in this study applies generally, it would be harder to successfully and ethically perform a randomized trial of medical prophylaxis.”
Perspective
Back to TopThe take-home message: The incidence of clinical CME may be lower than the 1% to 3% previously reported in the literature, and the role of prophylactic steroidal and nonsteroidal anti-inflammatory drops may play a role in reducing the incidence in our practice to 0.1%.
Effect on clinical practice: The study involved a computer search of records during which 2,862 consecutive cases of phacoemulsification cataract surgery IOL implantation were performed. During the 90-day postop follow-up period, three cases of cystoid macular edema were discovered. One was in a patient who had previous diabetic macular edema and focal photocoagulation. The second was in patient who had zonular dialysis during surgery and an anterior chamber IOL implanted. The final case was a routine case of cataract surgery. Final visual acuities were 20/20 to 20/30.
In our practice we routinely use antibiotic nonsteroidal and steroid drops preoperatively and postoperatively.