Intravitreal ketorolac for the treatment of chronic cystoid macular edema after cataract surgery

Tsilimbaris, Miltiadis K.; Tsika, Chrysanthi; Kymionis, George D.

doi:10.2147/tcrm.s97342

Cited by 5 publications

(2 citation statements)

References 16 publications

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“… 5 Options for prevention of ME after cataract surgery in patients with NPDR include preoperative treatment with steroids, intravitreal injections of anti-VEGFs, laser treatment, and topical NSAIDs. 17 It seems more prudent to prevent PCME rather than treat it, since treatment usually involves more invasive methods like intravitreal NSAID, 25 subtenon triamcinolone, 26 or intravitreal dexamethasone implant injections. 6 Boscia et al suggested that all diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PCME.…”

Section: Need For Prophylaxismentioning

confidence: 99%

Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Yüksel¹,

Kartı²,

Küsbeci³

2017

OPTH

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Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery.

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Section: Need For Prophylaxismentioning

confidence: 99%

Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Yüksel¹,

Kartı²,

Küsbeci³

2017

OPTH

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“…Options for prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy include preoperative treatment with steroids, intravitreal injections of anti-VEGFs, laser treatment, and topical NSAIDs. It seems more prudent to prevent PCME rather than treat it, since treatment usually involves more invasive methods like intravitreal NSAID, 111 subtenon triamcinolone, 112 or intravitreal dexamethasone implant injections. Boscia et al suggested that all diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PCME.…”

Section: Differential Diagnosis Of Cmementioning

confidence: 99%

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

Agarwal

Pichi

Invernizzi

et al. 2018

Ocular Immunology and Inflammation

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Uveitic cystoid macular edema (UME) is an important cause of visual morbidity among patients with both infectious and non-infectious uveitis. UME may be associated in more than 30% cases of active uveitis. However, even patients with minimal features of intraocular inflammation may develop recurrent or chronic UME. Therefore, the evaluation and management of UME in patients with uveitis may be challenging. A number of vitreoretinal pathologies may result in UME and accumulation of fluid in the intra-or subretinal space. These need to be carefully distinguished from each other so that appropriate management can be initiated. All types of uveitis, including anterior uveitis (where the primary site of inflammation is not in the posterior segment) can present with UME. Other conditions such as diabetes, and surgery, can present with macular edema. This index review highlights various differential diagnoses of UME and provides illustrative case examples with multimodal imaging evaluation.

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