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Study questions utility of topical NSAIDs to reduce already low incidence of macular edema in cataract surgery
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Topical NSAID use in patients who underwent cataract surgery was associated with a reduction in the already low incidence of postoperative macular edema, according to researchers.
In the retrospective matched cohort, a total of 108,093 patients underwent cataract surgery and 89,731 met inclusion criteria between January 2007 and June 2014 at Kaiser Permanente Southern California.
Those who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only.
An NSAID prescription was filled by 56.4% of patients. The prevalence of postoperative macular edema (PME) was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs.
While the change was statistically significant, researchers stated, “because the incidence of PME was low, the decreased incidence of PME results in a small reduction in the number of patients with PME.”
The researchers stated that in their analysis, 320 patients would need to be treated with perioperative NSAIDs to prevent one case of PME.
Prednisolone acetate was the most commonly dispensed topical and ketorolac was the most commonly dispensed NSAID.
NSAID use was associated with a lower incidence of PME in patients without diabetes and diabetes without retinopathy, researchers found.
Among patients with diabetic retinopathy, NSAID use was not associated with a change in the incidence of PME.
“The long-term visual consequences of developing PME in the absence of perioperative NSAIDs would be nominal for the majority of patients, further limiting the utility of prophylactic NSAID use, which only confers a small protective effect on disease incidence,” the researchers concluded. – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
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Modjtahedi BS, et al. Am J Ophthalmol. 2017;doi:10.1016/j.ajo.2017.01.006.
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