Treatment of cystoid macular edema after cataract surgery: a systematic review

Session Details

Session Title: Cataract Surgery Complications/Management

Session Date/Time: Monday 12/09/2016 | 16:30-18:15

Paper Time: 18:02

Venue: Auditorium C6

First Author: : L.Wielders THE NETHERLANDS

Co Author(s): :    J. Schouten   M. Aberle   V. Lambermont   F. van den Biggelaar   B. Winkens   R. Simons   R. Nuijts  

Abstract Details

Purpose:

Cystoid macular edema (CME) is one of the most frequent complications after cataract surgery. It resolves spontaneously in many cases, but long-standing CME may cause anatomic alterations and sustained visual impairment. At present, treatment is largely dependent on the preferences of individual ophthalmologists, since evidence-based guidelines are lacking. The current systematic review was performed to summarize and compare the results of previous randomized controlled trials (RCTs) investigating the optimal treatment of CME after cataract surgery.

Setting:

This systematic review was performed at the University Eye Clinic Maastricht UMC+, The Netherlands.

Methods:

The Cochrane, MEDLINE and EMBASE databases were searched in July 2015 to identify eligible articles. All RCTs comparing at least two treatments of any type, dosage or form were included in the study. Risk of bias and quality of the included RCTs was assessed using the Cochrane Collaboration’s tool for assessing risk of bias and Delphi criteria. Primary outcome was the percentage of patients with ≥2 lines improvement in corrected distance visual acuity (CDVA). Secondary outcome measures were the persistence of CDVA improvement after cessation of treatment and improvement of CME, according to the definition of the included trials.

Results:

The literature search retrieved 3135 titles; 9 RCTs were included in this systematic review. The overall quality was low to moderate and only one study included more than 50 subjects. Three studies comparing the efficacy of topical NSAIDs versus placebo reported a significantly larger CDVA improvement in the NSAID group. Others compared the efficacy of topical NSAIDs, topical corticosteroids, oral NSAIDs and oral acetazolamide. These studies included 10-39 subjects and none of them showed a statistically significant difference between treatment groups.

Conclusions:

The results of this systematic review suggest that topical NSAIDs can be used in treatment of CME after cataract surgery. It remains unclear which treatment is most effective to improve CDVA and retinal morphology. No large studies have compared the efficacy of various treatment strategies, which prevents evidence-based recommendations. Therefore, large multicenter studies are needed to investigate the optimal pharmacological treatment of acute and chronic CME after cataract surgery.

Financial Disclosure:

NONE