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    Examining NSAID prevention of pseudophakic CME

    Chicago—Adding a topical nonsteroidal anti-inflammatory drug (NSAID) to treatment with a topical corticosteroid significantly reduces the incidence of clinical pseudophakic cystoid macular edema (PCME) in at-risk eyes.

    Adjunctive topical NSAID use, however, has no effect on the development of clinical PCME in eyes without recognized risk factors, according to the results of a large, prospective, randomized, placebo-controlled trial presented at AAO 2016.

    The study, which was independently funded and had no industry support, included 1,000 eyes that were treated with topical prednisolone and randomly assigned 1:1 to treatment with either nepafenac 0.3% (Ilevro, Alcon Laboratories) or placebo once daily.

    Clinical PCME—defined as loss of two or more lines of BCVA and/or visually symptomatic distortion plus imaging evidence (OCT and fluorescein angiography) of CME—developed in 42 eyes overall (4.2%), and the incidence was significantly lower comparing the NSAID-treated eyes and the control group (p = 0.0001), said Sean J. McCafferty, MD.

    When eyes were stratified based on PCME risk factors, the incidence of PCME was 8.77% among the 308 at-risk eyes in the study and 2.17% in the nearly 700 eyes without any PCME risk factors, said Dr. McCafferty, a general ophthalmologist who practices in Tucson, AZ.

    A statistically significant benefit of topical nepafenac for reducing the incidence of PCME was observed only in the at-risk group (p = 0.00003).

    Changes in macular volume were also analyzed, and the data bolstered the main findings, showing that use of the topical NSIAD reduced macular thickness volume increases only in the at-risk group.

    “Patients with risk factors for PCME account for between 10% and 30% of cataract surgery patients seen in a general ophthalmology practice,” Dr. McCafferty said. “In the remaining 70% to 90%, it is unlikely that clinical PCME outcomes are improved with topical NSAID use.”

    Data collected in the study were also analyzed to determine the relative risk of PCME associated with different clinical features. The results showed the highest risk for PCME was in eyes with a history of PCME in the contralateral eye.

    Diabetic retinopathy, vein occlusion, macular hole, and epiretinal membrane were also associated with increased risk, whereas prostaglandin use and macular degeneration were not.

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