Bonnie An Henderson
CHICAGO — The use of NSAIDs and steroids can reduce cystoid macular edema and intracameral antibiotics can reduce infection for patients during lens-based surgery, a speaker said here.
“In diabetics, the PREMED study part 2 showed that subconjunctival steroid triamcinolone was also useful,” Bonnie An Henderson, MD, said at Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology annual meeting.
Patients at higher risk for cystoid macular edema are those with epiretinal membrane, diabetic retinopathy, vein occlusion, artery occlusions, uveitis or scleritis, and pseudoexfoliation syndrome, she said.
“Intraoperatively, if there is a complication during surgery, that is also associated with CME, but it is also associated with difficult surgery, such as prolonged hypotony, a lot of iris manipulation, or even prostaglandin or beta-blocker use,” she said.
The two-part PREMED study, which looked at prevention of macular edema after cataract surgery in diabetic patients, supported the use of NSAIDs in treating CME. In part 1, the researchers concluded that patients who received NSAIDs alone, or in combination with steroids, were at lower risk for CME compared with patients receiving only steroidals. In part 2, the researchers concluded that subconjunctival steroids better reduced macular thickness and volume than no subconjunctival steroid treatment. Additionally, intravitreal anti-VEGF had no effect on prevention of CME in diabetic patients, she said.
For ophthalmitis, decreasing possible sources of infection is the first safeguard for patients, for example, around the lids and lashes. If there is any systemic infection, surgery should be delayed, she said.
“The preoperative or perioperative use of antibiotics has been studied. What we can do to lower the antibacterial load before surgery has been combatted by use of topical antibiotics and the use of povidone iodine,” she said.
Preventing complications during surgery can also reduce rates of infection for patients. While there is no consensus, there is evidence to support use of intracameral antibiotics to prevent infection and is worthwhile to use postoperatively, she said. – by Robert Linnehan
Reference: Henderson BA. Prevention of cystoid macular edema and infection in lens-based surgery. Presented at: AAO Subspecialty Day; Oct. 26-27, 2018; Chicago.
Disclosure: Henderson reports no relevant financial disclosures.