Prevention of Cystoid Macular Edema After Cataract Surgery in Non-Diabetic and Diabetic Patients: A Systematic Review and Meta-Analysis

Kim, Stephen Jae; Jampel, Henry D.

doi:10.1016/j.ajo.2015.10.005

Cited by 8 publications

(6 citation statements)

References 6 publications

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“…However, the incidence of Irvine-Gass syndrome after modern phacoemulsification is very low, ranging between 0.1-2.4%, although it is reported to be much higher in diabetic patients reaching 20% 7,12,36 . Moreover, in the majority of cases, Irvine-Gass syndrome occur between 4-10 weeks postoperatively, which is shorter than the mean time of recurrence of macular edema both in our study and in previous reports 37,38 , while other studies supported that the inflammatory signal process after cataract surgery is believed to be short-lived and macular edema may develop in as little as 1 month after surgery 30,39 . By inserting the implant one month prior to cataract surgery, the peak action of the drug (30-60 days) and duration of action of the drug (roughly 4 months) can theoretically control more effectively both diabetic macular edema and Irvine-Gass syndrome, especially in cases where either or both of them occurred within the first month after cataract surgery, as previously reported 7,30,39 .…”

Section: Discussionsupporting

confidence: 68%

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Kabanarou¹,

Xirou²,

Boutouri³

et al. 2020

Sci Rep

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to examine preoperative use of intravitreal dexamethasone implant in patients with refractory diabetic macular edema (DME) undergoing cataract surgery. Participants in this study were 17 patients with DMe refractory to previous treatment with anti-vascular endothelial growth factor agents or dexamethasone implant, and co-existent cataract. All participants received intravitreal dexamethasone implant at baseline and underwent phacoemulsification within one month after its insertion. Bestcorrected visual acuity (BCVA) and central subfield thickness (CST) changes between baseline, time of cataract surgery and postoperative months 1, 2 and 3 were evaluated. At month 1 after surgery, BCVA improved significantly from 42.3 ± 9.6 to 58.7 ± 11.9 letters compared to baseline (p < 0.001) and the improvement was sustained at month 2 and month 3 postoperatively. One month postoperatively, CST improved significantly compared to baseline (p < 0.001) and the improvement was sustained at month 2 (p < 0.001), while at month 3 CST started to increase, but remained significantly lower than baseline (p = 0.003). At month 3 postoperatively, 35.3% of patients presented recurrence of ME. Patients with refractory DME and cataract can safely undergo phacoemulsification when dexamethasone implant is inserted one month prior to surgery to ensure adequate control of postoperative inflammation and prevent deterioration of Me. Diabetic macular edema (DME) is a common complication of diabetes mellitus, affecting about 20% of patients with diabetic retinopathy, and can lead to visual loss if left untreated 1,2. Patients with diabetes mellitus seem to develop cataract more frequently and earlier compared to non-diabetic population, because of the inherent metabolic condition of the disease 3-5. It is worthy to note that cataract surgery in diabetic patients has been associated with higher risk of complications, including postoperative macular edema (Irvine-Gass syndrome) or worsening of pre-existing DME, especially in the presence of unstable diabetic retinopathy 6-12. In fact, it has been reported that about 22% of diabetic patients, who undergo cataract surgery, develop macular edema 7. Previous studies have shown that intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents or triamcinolone pre-operatively, post-operatively or at the time of phacoemulsification may reduce the development of postoperative DME, although rapid recurrence of macular edema occurred and in case of triamcinolone the risk of intraocular pressure (IOP) increase may also exist 13-22. Intravitreal dexamethasone implant (Ozurdex, Allergan) is a biodegradable corticosteroid implant, which provides sustained-release of 700 μg dexamethasone into the vitreous for up to 6 months 23. It has been successfully applied for the treatment of DME, retinal vein occlusion and non-infectious posterior uveitis 24-26. There are few studies using intravitreal dexamethasone implant to control postoperative macular edema in patients affected by DME, showing promis...

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Section: Discussionsupporting

confidence: 68%

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Kabanarou¹,

Xirou²,

Boutouri³

et al. 2020

Sci Rep

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“…Even in routine cataract surgery, ME can develop secondary to the inflammatory cascade, despite the use of postoperative steroid eye drops. 33 We believe that injecting DEX directly into the eye where it is needed at the beginning of this inflammatory signal cascade could blunt or prevent the occurrence of ME among diabetics, as demonstrated by this study.…”

Section: Discussionmentioning

confidence: 52%

Effect of an Intravitreal Dexamethasone Implant on Diabetic Macular Edema After Cataract Surgery

Calvo

Ferreras

Adel

et al. 2018

Retina

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“…It was, however, pointed out that the review included studies of all PCME, regardless of whether or not it was associated with decreased vision, and that it provided no information to support the conclusion that NSAIDs are more effective than corticosteroids at reducing PCME. 61 …”

Section: Recommendationsmentioning

confidence: 99%

Pseudophakic cystoid macular edema: update 2016

Grzybowski¹,

Sikorski²,

Ascaso³

et al. 2016

CIA

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Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice.

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Prevention of Cystoid Macular Edema After Cataract Surgery in Non-Diabetic and Diabetic Patients: A Systematic Review and Meta-Analysis

Cited by 8 publications

References 6 publications

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Effect of an Intravitreal Dexamethasone Implant on Diabetic Macular Edema After Cataract Surgery

Pseudophakic cystoid macular edema: update 2016

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