Changing the game in treatment of acute pseudophakic CME
Joshua Mali, MD, provides clinical evidence and recommendations for pseudophakic CME and represents a new formal standard to first-line management.
As a retinal surgeon, I am constantly evaluating new technologies and medications to help give patients the best possible visual outcomes.
Pseudophakic cystoid macular edema (CME), also known as Irvine-Gass syndrome, is one of the most common causes of visual loss after cataract surgery.1
In 1953, Irvine described a CME that specifically resulted after cataract surgery.2
In addition, Gass and Norton also extensively studied the disease with fluorescein angiography.3,4
Phacoemulsification and small-incision cataract surgery have significantly reduced the incidence of pseudophakic CME, but because cataract surgery is the most commonly performed surgery in the United States, pseudophakic CME remains a commonly encountered morbidity.5,6
The approximate incidence of clinical CME after small-incision phacoemulsification is estimated to be between 0.1% to 2.35%.7,8
Previous studies have examined Medicare patients who underwent modern cataract surgery and determined that the total ophthalmic payments were 47% higher for those who developed pseudophakic CME compared with those who did not, thus representing a significant cost to the healthcare system.9
Topical NSAID
Bromfenac ophthalmic solution 0.075% (BromSite, Sun Ophthalmics) is a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of postoperative inflammation and prevention of ocular pain in patients undergoing cataract surgery.10 Bromfenac is the active molecule that is designed for improved corneal penetration given the bromine component which allows for enhanced lipophilicity and ocular tissue penetration.
However, the key feature of this medication is the delivery system (DuraSite) that allows the delivery vehicle to be more viscous and mucoadhesive-thus increasing retention time on the ocular surface and allowing for a higher intraocular concentration of bromfenac. This higher intraocular concentration is critical to treat diseases of the posterior segment, including Irvine-Gass CME.
Since the FDA approval and launch of the product in 2016, I have taken the opportunity to utilize it in my acute CME patients and have observed tremendously successful results.
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