Preventing cystoid macular edema after uncomplicated cataract surgery in non-diabetic and diabetic patients: a systematic review and meta-analysis

Session Details

Session Title: PCO. Cataract Surgery Complications/Management

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 09:42

Venue: Room 1

First Author: : L.Wielders THE NETHERLANDS

Co Author(s): :    J. Schouten   F. van den Biggelaar   V. Lambermont, Rob W.P. Simons   G. Worthy   B. Winkens   R. Nuijts     

Abstract Details

Purpose:

Cystoid macular edema (CME) is one of the most frequent complications after cataract surgery. It may cause suboptimal visual acuity after otherwise uncomplicated cataract surgery in 0-6% of non-diabetic patients and in up to 56% of diabetic patients. Many treatments have been studied to identify the optimal preventive treatment after surgery. The current systematic review was performed to summarize and compare all previous randomized controlled trials (RCTs) on the prevention of CME after cataract surgery in non-diabetic and diabetic patients.

Setting:

This systematic review and meta-analysis was performed at the University Eye Clinic Maastricht UMC, The Netherlands

Methods:

The Cochrane, MEDLINE and EMBASE databases were searched to identify all eligible articles. All RCTs comparing at least two preventive strategies of any type, dosage or form were included and all investigated treatments were classified into predefined treatment groups. 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. The primary outcome was the incidence of CME within 3 months postoperatively. Secondary outcome measurements were the central foveal thickness, macular volume and corrected distance visual acuity changes within 3 months postoperatively, as compared to baseline.

Results:

The literature search retrieved 2808 titles; 30 RCTs were included in this systematic review. In the non-diabetic population, topical non-steroidal anti-inflammatory drugs (NSAIDs) reduced the odds of developing CME after cataract surgery as compared to topical corticosteroids (odds ratio (OR) 0.11; 95%-confidence interval (95%-CI) 0.03-0.37). In both non-diabetic and diabetic populations, a combination of topical NSAIDs and corticosteroids significantly reduced the odds of developing CME as compared to topical corticosteroids as a single-drug treatment with an OR of 0.21 (95%-CI 0.10-0.44) and 0.17 (95%-CI 0.05-0.50), respectively.

Conclusions:

According to the current literature, topical NSAIDs should be used in all patients to prevent CME after cataract surgery. It remains unclear whether NSAIDs as a single-drug treatment are as effective as combination treatments.

Financial Interest:

NONE