Careful surgical technique and chemoprophylaxis are important for avoiding cystoid macular edema (CME) and endophthalmitis after lens-based surgery, said Bonnie An Henderson, MD.
“Meticulous surgery that minimizes the risk for intraoperative complications will help to prevent CME. Now there is also level 1 evidence showing the value of topical anti-inflammatory medications as a prophylactic strategy,” said Dr. Henderson, private practice, Ophthalmic Consultants of Boston, and clinical professor of ophthalmology, Tufts University School of Medicine, Boston.
Although for decades surgeons have been using topical nonsteroidal anti-inflammatory drugs (NSAIDs) peri- and postoperatively to prevent CME, strong data supporting this intervention continues to be reported with recent large studies.
Dr. Henderson noted that the American Academy of Ophthalmology Cataract in the Adult Eye Preferred Practice Pattern, which was released in 2016, stated that the available evidence suggests that NSAIDS only be used to prevent CME in patients with diabetic retinopathy or other high-risk ocular comorbidities. However, two recent meta-analyses, a report from the ASCRS Cataract Clinical Committee, and two recent prospective studies concluded that topical NSAIDs have value as a prophylactic strategy.
Bonnie An Henderson, MD
E: [email protected]
This article was adapted from Dr. Henderson's presentation during Refractive Surgery Subspecialty Day at the 2018 meeting of the American Academy of Ophthalmology. Dr. Henderson is a consultant to Alcon Laboratories, Allergan, Sun Pharmaceuticals, and Kala Pharmaceuticals and receives lecture fees from Alcon.