European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1

Abstract

Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug.

Cystoid macular oedema following cataract surgery: A review

“…Non‐diabetic patients (914 eyes) were randomized to receive either topical bromfenac 0.09% or dexamethasone 0.1% or a combination of both. The lowest incidence of clinically significant macular oedema was observed in the combination (steroid‐NSAID) treatment group (1.5%), compared to bromfenac (3.6%) or dexamethasone alone (5.1%) …”

“…Recently, a randomized controlled multicentre clinical trial; the PREvention of Macular EDema after cataract surgery (PREMED) study, was conducted in an effort to clarify the conflicting evidence and identify the optimum treatment for the prevention of PCMO after uneventful cataract surgery. 35,36 Non-diabetic patients (914 eyes) were randomized to receive either topical bromfenac 0.09% or dexamethasone 0.1% or a combination of both. The lowest incidence of clinically significant macular oedema was observed in the combination (steroid-NSAID) treatment group (1.5%), compared to bromfenac (3.6%) or dexamethasone alone (5.1%).…”

“…The lowest incidence of clinically significant macular oedema was observed in the combination (steroid-NSAID) treatment group (1.5%), compared to bromfenac (3.6%) or dexamethasone alone (5.1%). 35 In the PREMED study diabetic patients (213 eyes) were randomized to receive either no additional treatment or: 40 mg triamcinolone acetonide subconjunctival injection; 1.25 mg bevacizumab intravitreal injection or a combination of both injections. All diabetic patient groups also received pre and postoperative topical bromfenac 0.09% and dexamethasone 0.1%.…”

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

“…CMO can also occur in the setting of uncomplicated cataract surgery, with published incidence rates ranging from 1.2-3.4% [5][6][7][8][9][10]. Known as Irvine-Gass syndrome for the past 60 years, patients commonly experience good A version of this study was an oral presentation at the Scottish Ophthalmological Club meeting in February 2020, accepted as a poster presentation at RCOphth Annual Congress, Birmingham, UK in May 2020 (postponed due to COVID-19 restrictions) and has been submitted as an oral presentation at the ESCRS annual meeting, Amsterdam, October 2020. vision in the immediate post-operative period, followed by a painless central visual deterioration a few weeks later [7].…”

Topical non‐steroidal anti‐inflammatory drugs are not the mainstay of prophylaxis and treatment for pseudophakic cystoid macular oedema: Response

“…Following a challenge, this was later clarified in a subsequent reply.” Interestingly, as far as we can discern from the reply of Kessel et al (to a letter from the correspondents) they further explain, but do not actually resile from any of, the observations made in their systematic review The correspondents state “In a similar fashion, the PREMED study 6 quoted was unable to show a visual benefit in patients assigned to receive NSAID.” However, we actually note in respect to the PREMED study “the lowest incidence of clinically significant macular oedema was observed in the combination (steroid‐NSAID) treatment group (1.5%), compared to bromfenac (3.6%) or dexamethasone alone (5.1%).” Thus there appears to be a clinical, if not vision, benefit of NSAIDS in this randomized controlled study (Level 2 Evidence) Finally the correspondents suggest, “The article by Donnenfeld et al has also been included as evidence that PCMO was lower in groups where NSAIDs were commenced between 1 to 3 days preoperatively.…”