Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo

BMC Ophthalmology

Research Article

Meisha Raven¹  Corin Kew¹  Tala Kassm¹  Lisa Lane¹  Jason Levine²  Sean McCafferty²  April Harris³ 

[1] Arizona Eye Consultants, 355 N. Silverbell Ave, 85745, Tucson, AZ, USA;Arizona Eye Consultants, 355 N. Silverbell Ave, 85745, Tucson, AZ, USA;University of Arizona, 6422 E. Speedway Ave, 85710, Tucson, AZ, USA;Retina Associates of Tucson, 6561 E. Carondelet Dr, 85710, Tucson, AZ, USA;University of Arizona, 6422 E. Speedway Ave, 85710, Tucson, AZ, USA;

关键词: Cataract Surgery;    Well Correct Visual Acuity;    Macular Hole;    Retinal Vein Occlusion;    Branch Retinal Vein Occlusion;   

DOI  :  10.1186/s12886-017-0405-7

 received in 2016-10-19, accepted in 2017-01-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDefine the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study.MethodsEyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use.ResultsPCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk.ConclusionPseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors.Trial registrationNIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945.

【 授权许可】

CC BY   
© The Author(s). 2017