Medical Prophylaxis and Treatment of Cystoid Macular Oedema after Cataract Surgery

A Cochrane review [Abstract] 1 included 7 studies on the treatment of acute (3 studies) or chronic (4 studies) cystoid macular oedema (CMO), with a total of 266 subjects. In the studies examining chronic CMO, four different NSAIDs were used and administered in different ways. Indomethacin was used orally and was found to be ineffective for chronic CMO in one trial. Topical fenoprofen was also found to be ineffective for chronic CMO in another small trial. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. For the treatment of acute CMO with topical NSAIDs, the studies are too heterogeneous and small for conclusions.

Another Cochrane review [Abstract] 2 included 34 studies involving over 5 000 participants assessing the prophylactic use of topical NSAIDs postoperatively. People receiving topical NSAIDs in combination with steroids compared with steroids alone may have a lower risk of poor vision due to CMO and lower risk of CMO at 3 months after cataract surgery (table T1). Comparing NSAIDs alone with steroids, central retinal thickness was lower in the NSAIDs group at 3 months (mean difference MD -22.64 µm, 95% CI -38.86 to -6.43; 2 trials, 121 eyes). None of the studies comparing NSAIDs with steroids reported on poor vision due to CMO.

References

• Sivaprasad S, Bunce C, Patel N, Jyothi S. Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery. Cochrane Database Syst Rev 2005 Jan 25;(1):CD004239 [Last assessed as up-to-date: 5 August 2011][PubMed]
• Lim BX, Lim CH, Lim DK et al. Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database Syst Rev 2016;(11):CD006683. [PubMed].