NSAIDs help reduce CME rate after cataract surgery
A treatment protocol consisted of Omidria and BromSite with no steroids.
Only two of 504 eyes developed cystoid macular edema after undergoing cataract surgery and treatment with intraoperative and postoperative NSAIDs without steroids, according to a study.
“Two NSAIDs are better than one at preventing cystoid macular edema, and you can eliminate the steroid altogether,” study co-author Keith Walter, MD, told Ocular Surgery News.
Walter and colleagues conducted a retrospective cohort study to determine the rate of postoperative CME in patients undergoing cataract surgery and intraoperative intracameral infusion of Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros) and postoperative BromSite (bromfenac ophthalmic solution 0.075%, Sun Ophthalmics) with no steroids.
Reducing steroid burden
Steroids are known to cause delayed healing and suppression of immune function. They may also increase IOP, Walter said.
“In addition, steroids are typically four to six times a day with a complicated tapering schedule and have poor insurance coverage, which means generic substitution is likely and another co-pay for the patient,” he said.
The researchers reviewed 824 patient records, of which 320 were excluded due to inadequate follow-up. The final study cohort included 504 eyes.
Patients received Omidria at the beginning of surgery after paracentesis and then administered as a continuous infusion. Additionally, all patients were treated with topical bromfenac 2 days preoperatively and 28 days postoperatively using once-daily dosing.
Low CME rate
At final follow-up, only two eyes developed CME, for a rate of 0.4%. One patient regained 20/20 vision by postoperative month 3. The other patient had a chronic intraretinal cyst that may have been preexisting, but vision improved to 20/25 after 6 months, Walter said.
Historically, the rate of CME after cataract surgery using postoperative topical corticosteroids ranges from 1% to 5% in clinical studies, including patients with no risk factors, the study authors said.
Postoperative steroid drops can be burdensome, especially for older patients who may be required to take three different eye drops with three different schedules, Walter said.
“Family members are often required to take off work to give grandma her drops. Three brand-name drops can run the patient $500 or more. With our method, we give moxifloxacin intracamerally at the end of surgery and then once-daily BromSite 2 days before and 28 days later, in addition to Omidria. This affords a very easy and pleasant experience for the patient,” he said.
In addition to preventing intraoperative miosis and reducing pain, Omidria can also play an important role in the prevention of postoperative CME, Walter said. By limiting prostaglandin formation in the eye during surgery, surgeons can suppress the pupil from becoming smaller and lower the risk for postoperative CME.
“At the end of the case, if all the prostaglandins are suppressed, then it lessens postoperative pain and postoperative inflammation resulting in CME,” Walter said.
Omidria has been shown to reduce surgery times, decrease complication rates, and reduce the need for perioperative and postoperative opioids, he said.
- Walter K, et al. J Cataract Refract Surg. 2020;doi:10.1097/j.jcrs.0000000000000062.
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- Keith Walter, MD, can be reached at Wake Forest University Eye Center; email: email@example.com.