• Cataract/Anterior Segment, Comprehensive Ophthalmology

    This prospective, multicenter trial randomized 546 patients with no known risk factors for cystoid macular edema to one of two regimens: ketorolac tromethamine 0.4% QID and prednisolone acetate 1% QID until they exited the study at about four weeks postop, or prednisolone acetate 1% QID and artificial tears QID until one 5-ml bottle was empty until they exited the study.

    The ketorolac/steroid group also received topical ketorolac 0.4% QID for three days preoperatively. Patients in the steroid-only group used an artificial tear solution QID for three days prior to surgery. Both groups received four doses of ketorolac 0.4% one hour before surgery.

    No patient in the ketorolac/steroid group developed CME, compared to five patients (1.8 percent) in the control group.  No statistically significant difference was found between groups for BCVA. However, a subanalysis detected a statistically significant relationship between greater retinal thickening and decreased contrast sensitivity that the authors believe warrants further study.  

    The authors note that:

    "The costs associated with the management of CME and any sequelae can be considerable. Among Medicare patients in the United States receiving cataract surgery between 1997 and 2001, claims were 41% ($3,298) higher among patients who developed CME than among those who did not. Although the rate of CME was higher in patients with diabetes, the increased costs associated with CME were the same among diabetic and nondiabetic patients."

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