Preventing Macular Thickening After Cataract Surgery
JAMA Ophthalmology, October 2021
Which regimen is most effective at preventing postoperative thickening of the central macula following cataract surgery? Erichsen et al. compared a combination of NSAID and corticosteroid eyedrops, NSAID monotherapy, and a sub-Tenon depot of dexamethasone (dropless surgery). They also evaluated whether starting eyedrops three days before surgery was superior to starting them on the day of surgery. They found that combination therapy was not superior to NSAID monotherapy or dropless surgery.
For this single-center trial, 470 patients were randomized to 1 of 5 regimens: 1) preoperative combination drops (prednisolone plus NSAID); 2) post-op combination drops; 3) pre-op NSAID monotherapy; 4) post-op NSAID monotherapy; or 5) dropless surgery. Eyedrops were administered three times per day until three weeks postoperatively. The main outcome measure was central subfield thickness (CST) at the three-month mark.
Three months after surgery, the mean CST was 250 µm in both the pre- and post-op combination groups, 251.3 µm in the pre-op NSAID monotherapy cohort, 249.2 µm in the post-op NSAID monotherapy group, and 255.2 µm in the dropless surgery cohort.
With regard to other outcomes, more than half of the patients in the sub-Tenon group required anti-inflammatory eyedrops following surgery. Mean IOP decreased in all groups postoperatively, but it was lower in those who did not receive prednisolone in the early post-op period. There were no elevations of greater than 25 mm Hg at any postoperative visit. There were no differences in visual acuity between groups at any post-op time point, but adverse events and unscheduled visits took place more often among those in the dropless surgery cohort.
Given these findings, NSAID monotherapy with initiation on the day of surgery may be preferred as an anti-inflammatory regimen for patients undergoing uncomplicated cataract surgery, the authors said.
The original article can be found here.