Pseudophakic cystoid macular edema: update 2016

Abstract

Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice.

Anti‐inflammatory medication following cataract surgery: a randomized trial between preservative‐free dexamethasone, diclofenac and their combination

“…Nepafenac has established a wide market share (Margulis et al 2017). Further studies are needed to optimize the length of treatment and follow-up, to investigate the potential of preoperative medication (Grzybowski et al 2016) and to elucidate the effectiveness, tolerability and compliance between topical NSAID regimens. Keeping in mind the considerable incidence of irritation after topical preservative-free DICL that did not, however, reflect as compliance problems, our findings favour choosing DICL instead of DEX as the first-line postoperative medication after cataract surgery in preventing PCME, and to reserve DEX for the combination therapy for patients with highest risk of postoperative complications.…”

“…In addition, concerns of drug tolerability differences between NSAIDs and corticosteroids have emerged (Duong et al 2014;Kessel et al 2014;Kim et al 2015;Cardascia et al 2016;Coassin et al 2016;Grzybowski et al 2016;Lim et al 2016;Malik et al 2016;Duan et al 2017;Pollack et al 2017). The main interest revolves around the question whether the choice between topical corticosteroids or nonsteroidal anti-inflammatory drug (NSAID) affects postoperative inflammation or the risk of developing pseudophakic cystoid macular oedema (PCME; also, known as Irvine-Gass syndrome), and whether the choice has an impact on the speed of visual recovery and acuity gain.…”

“…The data on efficacy in the management of anterior chamber inflammation between topical corticosteroids and NSAID remain conflicting; however, the choice of NSAID may result in less PCME (Henderson et al 2007;Kim et al 2010;Duong et al 2014;Kessel et al 2014;Wielders et al 2015;Grzybowski et al 2016;Malik et al 2016;Duan et al 2017). Prior randomized clinical trials often lack head-tohead comparison between the most potent corticosteroid and NSAID eye drops in prevention of PCME (Shimura et al 2007;Miyake et al 2011).…”

Prevention of macular oedema after cataract surgery in patients with diabetes mellitus

“…Так-же КМО подразделяют на ангиографический (выявляется только при ФАГ или ОКТ и не сопровождается снижением остроты зрения) и клинически значимый (сопровождается снижением остроты зрения) [7].…”

“…Клинически значимый КМО можно выявить уже при оф-тальмоскопии, данная форма сопровождается снижением остроты зрения и обнаруживается в 0,1-2,35% [7,8]; по дан-ным флуоресцентной ангиографии (ФАГ) к концу первого месяца после операции КМО встречается в 16-40% слу-чаев [9]; по данным оптической когерентной томографии (ОКТ) -в 7,5% [10]. Вероятность развития КМО в послеопе-рационном периоде существенно повышается у пациентов группы риска, к которым относятся пациенты с СД.…”