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    Key strategies for treating postsurgical CME

    Current concepts analysis for preserving vision in Cystoid macular edema patients

     

    “Keep in mind that about 20% of patient’s with CME may recur,” he said. “Patients recover, then a month later they are edematous again. For these cases, you can use a (potent) topical steroid and an NSAID. The combination has already demonstrated efficacy, now you just need to deal with the rebound effect.”

    Complications from CME treatment

    The most frequent complication from treatment is increased IOP, which are more common if given parentally than with topical treatments. CME patients who have not had prior cataract surgery are also more prone to form cataracts. But the consequences of not treating CME are even worse.

    “These patients lose vision,” Dr. Warren said. “They may see well, but they all complain that color perception and contrast sensitivity are lost. That’s why  prevention of CME is so important.”

    Several retinal diseases appear to share the inflammatory pathway that can lead to CME, including uveitis, endophthalmitis, diabetic macular edema, retinal veno-oclusive disease and age-related macular degeneration. This common pathway suggests that patients with any pre-existing ocular inflammation, epiretinal or vitreoretinal interface membrane problems or ocular vascular disease; diabetes; macular degeneration, or any intraocular surgery are at increased risk for CME.

    There are no formal guidelines for the prophylaxis of CME, Dr. Warren noted. But early clinical data suggest that pre-treatment with a nonsteroidal anti-inflammatory as well as pre- or intraoperative corticosteroid use may reduce the incidence of CME in high-risk patients.

    Preoperative retinal photographs and OCT may also help identify high-risk patients who are more likely to benefit from prophylactic treatment.

     

    Keith Warren, MD

    E: [email protected]

    This article was adapted from Dr. Warren’s presentation at the 2015 meeting of the American Society of Cataract and Refractive Surgery. Dr. Warren serves as a consultant and speaker for Alcon Laboratories, DORC (Dutch Ophthalmics), and Genentech.

     

     

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