Research studies find that normalization of IOP at the end of cataract surgery can reduce the risk of cystoid macular edema (CME) and mitigate the need for adjunctive perioperative NSAID treatment in routine cases involving patients without diabetes.
Reviewed by John S. Jarstad, MD
The use of tonometry to check and guide adjustment of IOP immediately at the end of cataract surgery can reduce the risk of cystoid macular edema (CME). After that, patients can receive a topical corticosteroid postoperatively; perioperative nonsteroidal anti-inflammatory drug (NSAID) use may not be essential in routine cases.
Adjunctive NSAID treatment, however, is essential to reduce the risk of CME in all patients with diabetes and is also recommended in any case where there is an intraoperative complication or other risk factor for CME, said John S. Jarstad, MD. Dr. Jarstad’s comments were based on studies conducted at the Department of Ophthalmology, University of Missouri School of Medicine, Columbia, where he is associate professor of clinical ophthalmology and director of cataract and refractive surgery.
“Our study looking at the effect of NSAIDs on CME is the largest study to date on this topic, but it is retrospective,” he said. “The findings on omitting NSAIDs in routine cases if IOP is accurately assessed and adjusted into the normal range in the operating room should be investigated in a future controlled randomized trial.”
The incidence of CME in eyes operated on without perioperative NSAID use was investigated in a single surgeon retrospective study conducted by Dr. Jarstad as primary surgeon with the collaboration of Van Nguyen, MD, ophthalmology resident, and Carli Wittgrove, medical student.
The study included data from 930 eyes that underwent femtosecond laser-assisted cataract surgery (FLACS) or microincisional cataract surgery (MICS) between July 2016 and January 2018. “The period chosen for the study was a time when we were not using perioperative NSAIDs because of a supply shortage,” Dr. Jarstad explained.
“Rick Fraunfelder, MD, department chairman, suggested we review patients’ outcomes to investigate his impression that NSAIDs were not needed to prevent CME in routine cases.”
In all cases, IOP was checked and adjusted with BSS to between 16 mm Hg and 21 mm Hg using a sterile 27-gauge cannula with a Tono-Pen (AO Reichert) and sterile cover immediately after completion of surgery while the patient was still on the operating table. Patients whose visual acuity did not correct to 20/20 during follow-up were evaluated over the next several weeks with optical coherence tomography (OCT) of the macula to detect CME.
John S. Jarstad, MD
E: [email protected]
Dr. Jarstad has no relevant financial interests to disclose.