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NSAIDs linked to reduced rate of CME after cataract surgery

Issue: May 25, 2014

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BOSTON — NSAIDs reduced cystoid macular edema more than steroids after cataract surgery, according to a study presented here.

“We think that NSAIDS used routinely did better than guessing on the high-risk patients. Bromfenac alone may be equal or better than the steroid,” Keith Walter, MD, said at the American Society of Cataract and Refractive Surgery meeting. “Generic drops may be less effective, but a more prospective judicial use would need to be done in order to elucidate this further.”

Keith Walter

Walter and colleagues retrospectively examined more than 5,000 charts of patients who underwent cataract surgery and developed CME. They drew correlations between CME rates and treatment regimens.

The first regimen involved postoperative Pred Forte (prednisolone acetate ophthalmic suspension, Allergan) tapered for 5 weeks, with ketorolac 0.4% added for patients with a history of CME. Substitutions were allowed for the NSAID and steroid.

The second regimen involved postoperative prednisolone acetate 1% tapered, with ketorolac 0.04% for patients with a history of CME. Generic steroid and NSAID substitutions were allowed.

The third regimen involved postoperative Pred Forte tapered for 35 days, with Xibrom (bromfenac), which has been discontinued, twice daily for 1 month for high-risk patients. No generic substitutions were allowed.

The fourth regimen involved Bromday (bromfenac, Bausch + Lomb) starting 2 days preoperatively and ending 1 month postoperatively, with no steroids and no generic substitutions.

CME rates were 0.9% with the first regimen, 2.21% with the second regimen, 0.44% with the third regimen and 0.09% with the fourth regimen. Differences between the first and fourth regimens and between the second and fourth regimens were statistically significant, Walter said.

Disclosure: Walter receives royalties for the EndoSaver instrument. He is a consultant to Abbott Medical Optics and Bausch + Lomb.