Particularly convincing is the ESCRS PREMED study that randomized 914 non-diabetic patients who underwent uneventful cataract surgery into one of three arms to receive topical bromfenac, topical dexamethasone, or bromfenac plus dexamethasone. The results showed the incidence of clinically significant macular edema was lowest in the group that received combination therapy and that postoperative macular thickness and total macular volume were lower in patients treated with the topical NSAID than in patients in the topical corticosteroid group.
A second arm of the ESCRS PREMED study focused on preventing CME in patients with diabetes. It included 213 patients. All participants were treated with topical bromfenac and topical dexamethasone, and they were randomized to receive no additional treatment, subconjunctival injection of triamcinolone, intravitreal bevacizumab 1.25 mg, or triamcinolone plus bevacizumab. Results of this study showed that macular thickness and macular volume were lowered by treatment with the subconjunctival corticosteroid, while the anti-VEGF injection had no significant benefit.
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.