Injectable treatments for pseudophakic cystoid macular edema deserve further research
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A growing body of real-world data shows efficacy of injectable treatments for pseudophakic cystoid macular edema, but evidence from well-designed large studies is lacking, according to a systematic literature review.
As noted by the authors, treatment of pseudophakic cystoid macular edema (PCME) is controversial, and there are no standardized guidelines. Topical NSAIDs are usually administered as first-line treatment, alone or in combination with topical corticosteroids. However, some patients do not respond well to the therapy and experience chronic or recurrent edema. Injectable treatments, including intravitreal anti-VEGFs, steroids and tumor necrosis factor-alpha inhibitor injections, as well as sub-Tenon steroid injections and intravitreal steroid implants, are used off label in these cases.
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To characterize the current evidence surrounding these treatments, a systematic literature review was performed on the PubMed and Embase databases. Out of 690 records, including 51 full-text studies, 18 studies with a mean sample size of 19 eyes and a mean follow-up of 9.7 months met the inclusion criteria and were included in the review.
All studies had positive conclusions. However, 15 reports were case series with no controls. Of the three studies that used a comparator, two found no statistically significant difference in visual and anatomic improvement between sub-Tenon triamcinolone injection and topical nepafenac in one case and sub-Tenon triamcinolone and retrobulbar triamcinolone in the other case. In a phase 3 clinical trial comparing intravitreal ranibizumab and sham in eyes with macular edema of various etiologies, a subgroup analysis of eyes with macular edema following cataract surgery showed significantly greater improvement in the ranibizumab group.
“The biggest limitations to this review were the characteristics of the available studies and the inconsistencies of PCME. Most of the available data were from low-quality retrospective case series,” the authors wrote. However, “despite the limitations of the available evidence, the current literature is optimistic and demonstrates an important area for future research.”
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