Effectiveness of NSAIDs in Preventing Pseudophakic Cystoid Macular Edema

A new study published in the International Journal of Retina and Vitreous showed that nonsteroidal anti-inflammatory drugs (NSAIDs), either by themselves or in conjunction with steroids, have demonstrated effectiveness in lowering the incidence of pseudophakic cystoid macular edema (PCME) following surgery.

Optical coherence tomography (OCT) analysis of cystoid macular edema (CME), which is a well-known surgical consequence, reveals central subfield macular thickness, cystic hyporeflective lesions, and subfoveal fluid. CME that occurs after cataract surgery is known as PCME. It is thought to be the most frequent reason for vision decline following surgery. The main theory for PCME is mechanical manipulation linked to the release of inflammatory mediators.

In order to successfully lower the incidence of PCME, no standardized preventive procedure has been developed as of yet. So, Abdullah Alqahtani and his colleagues evaluated the safety and effectiveness of corticosteroids and nonsteroidal anti-inflammatory drops in preventing PCME. This study included randomized controlled trials (RCTs) that examined the effectiveness of NSAID against placebo, steroid, or NSAID + steroid against placebo, which indicated the prevalence of macular thickness, PCME, and best-corrected visual acuity.

This analysis included a total of 18 RCTs (n = 2959). The risk of bias was categorized as follows:

• 2 RCTs had a high risk of bias
• 7 RCTs had an unknown risk of bias
• 9 RCTs had a low risk of bias

NSAID-treated individuals had a considerably decreased incidence of cystoid macular edema (RR = 0.33, P < 0.001). According to subgroup analysis, individuals using NSAIDs alone had a statistically significant lower probability of developing edema than other patients (P < 0.001). NSAIDs were linked to noticeably lower mean corrected visual acuity values (P < 0.001) by using LogMar.

The findings from this systematic review and meta-analysis revealed that NSAIDs, either by themselves or in conjunction with steroids, are effective preventative interventions that can lower the incidence of PCME. However, a variety of circumstances, such as intraoperative problems, ocular or systemic disorders, and surgical manipulation, contribute to its pathogenesis. Standardized preventive procedures are therefore required for every patient group, including those who are healthy, have ocular disorders, and have systemic diseases.

Source

Alqahtani, A. S., Hersi, R. M., Homsi, J. J., Alamoudi, L. O., Alghamdi, S., Alrajhi, R. K., & AlJehani, R. A. (2024). Prophylactic regimens for the prevention of pseudophakic cystoid macular edema: systematic review and meta-analysis. In International Journal of Retina and Vitreous (Vol. 10, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s40942-024-00588-8