Laura H P Wielders1, Verena A Lambermont2, Jan S A G Schouten2, Frank J H M van den Biggelaar2, Gill Worthy3, Rob W P Simons2, Bjorn Winkens4, Rudy M M A Nuijts2. 1. University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands. Electronic address: laura.wielders@mumc.nl. 2. University Eye Clinic Maastricht UMC+, Maastricht University Medical Center+, Maastricht, Netherlands. 3. Kleijnen Systematic Reviews Ltd, York, United Kingdom. 4. Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands.
Abstract
PURPOSE: To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery. DESIGN: Systematic review and meta-analysis. METHODS: setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs). STUDY POPULATION: RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabetic patients. OBSERVATION PROCEDURES: Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria. MAIN OUTCOME MEASURES: Odds of developing CME within 3 months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3 months postoperatively, as compared to baseline. RESULTS: Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03-0.37) and mixed populations (OR 0.05; 95% CI 0.02-0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10-0.44) and diabetic patients (OR 0.17; 95% CI 0.05-0.50). Intravitreal corticosteroid or anti-vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects. CONCLUSIONS: Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic and diabetic patients, as compared to topical corticosteroids.
PURPOSE: To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery. DESIGN: Systematic review and meta-analysis. METHODS: setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs). STUDY POPULATION: RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabeticpatients. OBSERVATION PROCEDURES: Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria. MAIN OUTCOME MEASURES: Odds of developing CME within 3 months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3 months postoperatively, as compared to baseline. RESULTS: Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03-0.37) and mixed populations (OR 0.05; 95% CI 0.02-0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10-0.44) and diabeticpatients (OR 0.17; 95% CI 0.05-0.50). Intravitreal corticosteroid or anti-vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects. CONCLUSIONS: Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic and diabeticpatients, as compared to topical corticosteroids.
Authors: Asieh Golozar; Yujiang Chen; Kristina Lindsley; Benjamin Rouse; David C Musch; Flora Lum; Barbara S Hawkins; Tianjing Li Journal: JAMA Ophthalmol Date: 2018-05-01 Impact factor: 7.389
Authors: Richard S Hoffman; Rosa Braga-Mele; Kendall Donaldson; Geoffrey Emerick; Bonnie Henderson; Malik Kahook; Nick Mamalis; Kevin M Miller; Tony Realini; Neal H Shorstein; Richard K Stiverson; Barbara Wirostko Journal: J Cataract Refract Surg Date: 2016-09 Impact factor: 3.351