Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

Shorstein, Neal H.; Liu, Liyan; Waxman, Michael D.; Herrinton, Lisa J.

doi:10.1016/j.ophtha.2015.08.024

Cited by 54 publications

(60 citation statements)

References 27 publications

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“…As with past studies, 3, 4 we excluded complex phacoemulsification cases and cases performed by glaucoma, oculoplastic or retinal specialists as well as procedures by any surgeon combined with corneal transplant (ICD-9 11.6, CPT4 codes 65710-65715) or glaucoma surgery (ICD-9 12.54, 12.64, 12.66, 12.69,-12.7, CPT4 codes 65850, 66170, 66172, 66180, 66185).…”

Section: Methodsmentioning

confidence: 99%

“…We counted only one case of macular edema per patient because it was not possible based on coding alone to determine the laterality of the macular edema or whether the condition was unilateral or bilateral. To improve specificity, 4 we required macular edema cases to have undergone ocular coherence tomography and to have filled a prescription for ophthalmic prednisolone during the 120 days after surgery.…”

Section: Methodsmentioning

confidence: 99%

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Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

et al. 2017

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Purpose We conducted a retrospective comparative-effectiveness study of best-corrected visual acuity (BCVA) and refractive error (RE) following immediate sequential (ISBCS) and delayed sequential (DSBCS) bilateral cataract surgery. We tested two hypotheses: (1) among DSBCS patients, 2nd eye outcomes were no different than 1st eye outcomes; (2) averaged between each patient’s two eyes, outcomes did not differ between ISBCS and DSBCS patients. Design Retrospective comparative-effectiveness study. Subjects Kaiser Permanente Northern California members who underwent non-complex bilateral cataract surgery during 2013 through June 30, 2015. Methods We performed an intention-to-treat analysis comparing ISBCS to DSBCS using conditional logistic regression analysis, accounting for surgeon and patient-level factors. Main Outcome Measures BCVA, RE. Results The analysis of visual outcomes included both eyes of 13,711 DSBCS and 3,561 ISBCS patients. Because of the large sample size, some statistical differences lacked clinical significance. Ocular comorbidities were slightly more prevalent in DSBCS patients. Postoperative BCVA was 20/20 or better in 48% of DSBCS 1st eyes, 49% of DSBCS 2nd eyes, 53% of ISBCS right eyes, and 51% of ISBCS left eyes. The within-person difference in postoperative BCVA averaged zero (0.00) between the 1st and 2nd DSBCS eyes, and between the ISBCS right and left eyes. After adjustment, average postoperative BCVA was better in ISBCS patients, although the difference was not statistically significant. (compared with 20/20 or better: odds ratio for worse than 20/20 was 0.91, 95% confidence interval 0.83–1.01). Emmetropia (spherical equivalent −0.5 to 0 D) was achieved in 61% of 1st DSBCS eyes, 61% of 2nd DSBCS eyes, 63% of ISBCS right eyes, and 62% of ISBCS left eyes. After adjustment, average postoperative RE was no different in ISBCS compared with DSBCS patients (compared with emmetropia: odds ratio for ametropia was 1.02, confidence interval 0.92–1.12). We confirmed one case of postoperative endophthalmitis in 10,494 ISBCS eyes (1.0 per 10,000 eyes), two cases in 38,736 DSBCS eyes (0.5 per 10,000 eyes) (p=0.6), and no patient had bilateral endophthalmitis. Conclusion Compared with DSBCS cataract surgery, we found no evidence that ISBCS surgery was associated with worse postoperative BCVA or RE, or with an increased complication risk.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

et al. 2017

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“…Another recent study that retrospectively reviewed more than 16 000 phacoemulsification surgeries by 17 surgeons defined clinical postoperative macular edema as a visual acuity of 20/40 or worse with confirmatory findings on OCT. 49 Compared with eyes that received prophylaxis with topical prednisolone alone, the eyes that were additionally treated with postoperative NSAIDs experienced a 55% reduction in the incidence of macular edema.…”

Section: Nonsteroidal Antiinflammatory Drugs and Cystoid Macular Edemamentioning

confidence: 99%

“…92 Recently, a comparative effectiveness retrospective study of over 4500 eyes that received generic diclofenac, flurbiprofen, or ketorolac revealed no corneal melts or other significant corneal events other than 1 instance of temporary mild corneal thinning in an eye treated with prednisolone alone in a patient with rheumatoid arthritis. 49 …”

Section: Adverse Effects Of Topical Nonsteroidal Antiinflammatory Drugsmentioning

confidence: 99%

Cataract surgery and nonsteroidal antiinflammatory drugs

Hoffman¹,

Braga-Mele²,

Donaldson

et al. 2016

Journal of Cataract and Refractive Surgery

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Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes.

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“…Both potent and weaker corticosteroids were less effective than NSAIDs in reducing the risk of CME. In addition, a large retrospective cohort study found that adding an NSAID to postoperative topical prednisolone acetate was associated with a lower risk of clinical CME compared with prednisolone therapy alone (odds ratio 0.45; 95% confidence interval 0.21–0.95) 24. Clinical CME was defined as evidence of macular thickening on OCT and VA of 20/40 or worse, ascertained between 5 and 120 days after cataract surgery.…”

Section: Introductionmentioning

confidence: 99%

Topical bromfenac for prevention and treatment of cystoid macular edema following cataract surgery: a review

Sheppard¹

2016

OPTH

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Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, alone or in combination, have historically been used off label in the US to prevent and treat postoperative cystoid macular edema (CME). This literature review presents available data on the use of bromfenac 0.07% or 0.09% to prevent and treat CME following cataract surgery. Bromfenac is an NSAID approved to treat postoperative inflammation and reduce ocular pain following cataract surgery. Few cases of clinical CME were observed with bromfenac use in a total of 19 reviewed studies. There were no significant differences in CME incidence between bromfenac and corticosteroid-treated patients or between bromfenac- and bromfenac plus corticosteroid-treated patients. Bromfenac demonstrated comparable efficacy to other NSAIDs in preventing CME. Compared with corticosteroids, bromfenac alone or plus a corticosteroid showed similar or better efficacy in minimizing changes in retinal thickness and macular volume. In diabetic cataract surgery patients, bromfenac was comparable or superior to corticosteroids for minimizing changes in retinal thickness; also, combination therapy with bromfenac and corticosteroids may be associated with smaller changes in foveal thickness, macular thickness, and macular volume versus monotherapy with either treatment alone in this patient population. In two randomized, double-masked, placebo-controlled clinical trials with bromfenac 0.07%, CME was reported as an adverse event in 0.5% and 1.5% of patients receiving bromfenac and placebo, respectively. In an analysis of four placebo-controlled trials with bromfenac 0.09%, macular edema was reported in 0.7% and 1.4% of patients receiving bromfenac and placebo, respectively. When evaluated as treatment for acute or chronic CME, bromfenac was associated with improvement in visual acuity and reduction in retinal thickness, but few studies are available. Overall, published data suggest that bromfenac is safe and effective when used to prevent or treat CME. Large-scale placebo-controlled trials and greater standardization of CME measures are needed to establish optimal bromfenac regimens for the prophylaxis and treatment of CME following cataract surgery.

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Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery

Cited by 54 publications

References 27 publications

Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

Cataract surgery and nonsteroidal antiinflammatory drugs

Topical bromfenac for prevention and treatment of cystoid macular edema following cataract surgery: a review

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