Efficacy of topical flurbiprofen and indomethacin in preventing pseudophakic cystoid macular edema

Solomon, Leon D.

doi:10.1016/s0886-3350(13)80484-1

Cited by 75 publications

(33 citation statements)

References 15 publications

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“…The postoperative visual acuity in patients with angiographic CME was reported to be significantly worse than in those without CME in previous studies [13, 14]. In our series, although the difference between groups was not statistically significant, the mean postoperative visual acuity appeared to be better in the angiographically CME-negative group than in the CME-positive group (0.89 ± 0.14 vs. 0.80 ± 0.13).…”

Section: Discussioncontrasting

confidence: 81%

Incidence of Cystoid Macular Edema after Uncomplicated Phacoemulsification

et al. 2003

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We determined the incidence and causes of clinical and angiographic cystoid macular edema (CME) after uncomplicated phacoemulsification and intraocular lens implantation in otherwise normal eyes. This study comprised 252 eyes of 252 patients who had uncomplicated phacoemulsification with continuous curvilinear capsulorhexis and in-the-bag acrylic intraocular lens implantation. The presence of clinical and angiographic CME was evaluated 45 days after surgery, using fundus fluorescein angiography. Age, sex, cataract type, iris color, and real phacoemulsification time of the patients were also recorded. The mean age of the patients was 69.86 (range 60–82) years). Clinical CME was not detected in any eye at any postoperative visit. There were 23 cases with angiographic CME (9.1%). There were no significant differences between the groups who were later found to be angiographically CME-positive or CME-negative in any variable recorded (p >0.05). The incidences of clinical and angiographic CME after uncomplicated phacoemulsification were 0 and 9.1%, respectively. These results indicate that the occurrence of clinical CME has greatly reduced after uncomplicated phacoemulsification operations, but the incidence of angiographic CME is still nearly equal to the incidence of the extracapsular technique.

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Section: Discussioncontrasting

confidence: 81%

Incidence of Cystoid Macular Edema after Uncomplicated Phacoemulsification

et al. 2003

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“…CME can be classified as ‘clinically significant’ and ‘angiographic’ [7]; a variety of trials have demonstrated beneficial effects of NSAID for the prevention of ‘angiographic’ CME [7,10,11]. However, evidence for the prevention of ‘clinically significant’ CME remains less convincing, similar to the long-term benefits of NSAID treatment, if any.…”

Section: Discussionmentioning

confidence: 99%

Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

2010

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Background/Aims: To evaluate the benefit of adding a nonsteroid agent to an antibiotic/steroid combination after uneventful phacoemulsification, adopting a weekly follow-up, to gain insight into the optimal duration of postoperative treatment and to examine whether risk factors for inflammation exist. Methods: Patients were randomized to (i) tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d. (n = 72), and (ii) a combination of tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d., plus ketorolac tromethamine 0.5%, 1 drop t.i.d. (n = 73). On days 7, 14, 21 and 28, the frequency of inflammation-related signs (corneal edema, conjunctival hyperemia, anterior chamber or Tyndall reaction) as well as best-corrected visual acuity (BCVA) were measured. On day 21, logistic regression was performed to evaluate risk factors for inflammation. Results: The frequency of inflammation-related signs did not differ between the 2 groups at any time point, neither did BCVA. On day 21, pseudoexfoliation was associated with the presence of any inflammation-related sign (OR = 4.5; 95% CI: 1.2–16.0; p = 0.022). No evidence of clinically significant cystoid macular edema became evident in either group. Conclusion: The addition of ketorolac did not seem to offer any additional benefit in terms of inflammation-related signs. Four weeks appeared as an adequate treatment interval. Special attention should be paid to patients with pseudoexfoliation.

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“…However, in a large randomized, double-masked study, the flurbiprofen-CME study group demonstrated a lower incidence of symptomatic CME compared to controls, tested with contrast sensitivity and Snellen visual acuity measurements after application of indomethacin and flurbiprofen for 6 months after cataract surgery, but the effects were not sustained [97]. As most of the CME treatment studies include the concurrent use of corticosteroids, these studies represent the effects of a combined therapy with synergistic effects of NSAIDs and corticosteroids.…”

Section: Treatment and Prevention Of Cme After Cataract Surgerymentioning

confidence: 99%

Topical Nonsteroidal Anti-Inflammatory Therapy in Ophthalmology

Schalnus

2003

Ophthalmologica

142

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Topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the management and prevention of ocular inflammation and cystoid macular edema related to cataract surgery and the maintenance of mydriasis during cataract surgery. Other common uses are the reduction of discomfort after refractive surgery or in allergic conjunctivitis. NSAIDs primarily act as cyclooxygenase inhibitors and thus reduce the formation of endogenous PGs. Today, several NSAIDs are commercially available: diclofenac, flurbiprofen, indomethacin, ketorolac and suprofen. At present the ophthalmologist has to make a decision between the use of topical corticosteroids, with their potential adverse effects, or of topical NSAIDs, with their possibly increased benefit, unknown effect on ocular pressure, wound healing and corneal tissue, higher costs and limited track record. However, the improvement of surgical techniques might support an increasing use of NSAIDs in the future. Preoperative anti-inflammatory treatment should be considered in eyes at a higher risk of developing severe postoperative inflammatory reactions. This decision has to be made carefully and has to be guided by the clinical circumstances, the spectrum of diagnosis and the individual benefit-risk ratio of each patient.

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Efficacy of topical flurbiprofen and indomethacin in preventing pseudophakic cystoid macular edema

Cited by 75 publications

References 15 publications

Incidence of Cystoid Macular Edema after Uncomplicated Phacoemulsification

Incidence of Cystoid Macular Edema after Uncomplicated Phacoemulsification

Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

Topical Nonsteroidal Anti-Inflammatory Therapy in Ophthalmology

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