Incidence of cystoid macular edema following routine cataract surgery using NSAIDs alone or with corticosteroids

ABSTRACT Purpose: To evaluate the rate of cystoid macular edema development among cataract surgery patients on four different therapeutic regimens. Methods: The present study is a retrospective analysis of 5,380 eyes following uncomplicated phacoemulsification at Wake Forest University. The study period went from July 2007 to December 2012. Patients received one of four regimens, as follows: postoperative generic ketorolac 0.4% and prednisolone 1%, postoperative name-brand ketorolac 0.45% and prednisolone 1%, postoperative bromfenac 0.09% and prednisolone 1%, preoperative and postoperative bromfenac 0.09% alone. A statistical analysis was performed to assess the differences in rate of cystoid macular edema development among the four different therapeutic regimens. The diagnosis of cystoid macular edema required worsening of vision and evidence of increased macular thickness on optical coherence tomography. Results: The overall rate of cystoid macular edema was 0.82%. Treatment by postoperative generic ketorolac 0.45% and prednisolone 1% demonstrated the highest rate of cystoid macular edema development (2.20% of the cases). Postoperative name-brand ketorolac 0.45% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.90% of the cases). Postoperative administration of bromfenac 0.09% and prednisolone 1% exhibited intermediate rates of cystoid macular edema development (0.44% of the cases). Preoperative and postoperative bromfenac 0.09% alone resulted in the lowest rate of cystoid macular edema development (0.09% of the cases). The rate of cystoid macular edema was significantly lower when bromfenac was used alone vs. either regimen where ketorolac and prednisolone were used (OR 0.043, 95% CI 0.002 to 0.312; p<0.001). Conclusions: Post-cataract surgery cystoid macular edema developed less frequently following topical non-steroidal anti-inflammatory drugs regimen compared to the other therapies evaluated. Bromfenac, without corticosteroids, achieved lower rates of cystoid macular edema vs. various combinations of non-steroidal anti-inflammatory drugs with corticosteroids.

摘要
研究目的：评估接受白内障手术的患者在四种不同治疗方案下的囊样黄斑水肿（cystoid macular edema）发生率。
研究方法：本研究为回顾性分析，纳入维克森林大学（Wake Forest University）2007年7月至2012年12月期间接受单纯超声乳化白内障吸除术（uncomplicated phacoemulsification）的5380只患眼。患者被分配至四种治疗方案之一，具体如下：术后使用通用名酮咯酸（ketorolac）0.4%联合泼尼松龙（prednisolone）1%；术后使用品牌名酮咯酸0.45%联合泼尼松龙1%；术后使用溴芬酸钠（bromfenac）0.09%联合泼尼松龙1%；术前及术后单独使用溴芬酸钠0.09%。本研究通过统计学分析，评估四种治疗方案间囊样黄斑水肿发生率的差异。囊样黄斑水肿的诊断需满足视力下降及光学相干断层扫描（optical coherence tomography）显示黄斑厚度增加的影像学证据。
研究结果：总体囊样黄斑水肿发生率为0.82%。其中，术后使用通用名酮咯酸0.45%联合泼尼松龙1%的方案囊样黄斑水肿发生率最高（占病例的2.20%）；术后使用品牌名酮咯酸0.45%联合泼尼松龙1%的方案发生率处于中等水平（占病例的0.90%）；术后使用溴芬酸钠0.09%联合泼尼松龙1%的方案发生率同样处于中等水平（占病例的0.44%）；术前联合术后单独使用溴芬酸钠0.09%的方案发生率最低（占病例的0.09%）。与使用酮咯酸联合泼尼松龙的任一方案相比，单独使用溴芬酸钠时囊样黄斑水肿发生率显著更低（比值比（Odds Ratio）=0.043，95%置信区间（Confidence Interval）：0.002~0.312；P<0.001）。
研究结论：白内障术后囊样黄斑水肿在局部使用非甾体抗炎药（non-steroidal anti-inflammatory drugs）方案下的发生率低于本次评估的其他治疗方案。不含糖皮质激素的溴芬酸钠治疗方案，其囊样黄斑水肿发生率低于各类非甾体抗炎药联合糖皮质激素的治疗方案。