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

Session Details

Session Title: Cataract
Session Date/Time: Saturday 11/02/2017 | 08:30-11:00
Paper Time: 10:12
Venue: Auditorium 1

First Author: L.Wielders THE NETHERLANDS
Co Author(s): J. Schouten  M. Aberle  F. van den Biggelaar  B. Winkens  R. Simons  R. Nuijts   

Abstract Details

Purpose:

Postoperative cystoid macular edema (CME), also known as the Irvine-Gass syndrome, is an important cause of suboptimal visual acuity after cataract surgery. Acute CME 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 determine the optimal pharmacological 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 May 2016 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ﾒ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 3403 titles; 10 RCTs were included in this systematic review. The overall quality was low to moderate and only two studies included more than 40 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, subtenon corticosteroids, oral NSAIDs or oral acetazolamide. These studies included 10-48 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