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    Key strategies for treating postsurgical CME

    Current concepts analysis for preserving vision in Cystoid macular edema patients

     

    Nonsteroidal anti-inflammatory agents have traditionally been viewed as second-line agents. However, there is growing clinical evidence that these agents may play a role in the prophylaxis of CME.

    Nepafenac and bromfenac appear to be most effective, although ketorolac and diclofenac are also used. None of these agents are approved for use in CME, Dr. Warren noted, though all four are indicated for postoperative pain and inflammation.

    These four NSAIDs inhibit cyclooxygenase-2 (COX-2) and prostaglandin production. There is growing evidence that corticosteroids and NSAIDs may have a synergistic effect because each blocks different steps in the inflammatory cascade that may lead to CME.

    Combo therapy explored as alternative

    Dr. Warren’s research found that combination therapy including NSAIDs was more effective in improving visual acuity, reducing retinal thickness and maintaining reduced retinal thickness compared to corticosteroids and anti-VEGF therapy without NSAID use.

    CME treatment is usually stratified by the duration of disease, he continued. Acute CME that appears 4 to 6 weeks postop responds well to topical difluprednate plus an NSAID.

    For persistent CME lasting 8 weeks or longer, he recommends periocular (sub-tenon’s) steroid injection plus an NSAID. Chronic CME lasting 12 weeks or longer may require an intraocular steroid plus a topical NSAID. Recalcitrant CME lasting four months or longer needs more potent treatment including an intraocular steroid, anti-VEGF and NSAID.  If tolerated, a long-acting steroid implant should be considered. 

    Vitrectomy is usually the last resort, and as a rule has mixed results.

    Next: Complications from CME treatment

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