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Prophylactic non-steroidal anti-inflammatory agents for the prevention of macular oedema after cataract surgery

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Session Details

Session Title: Presented Poster Session: Complications Management in Cataract Surgery

Venue: Poster Village: Pod 1

First Author: : B.Lim SINGAPORE

Co Author(s): :    C. Lim   D. Lim           

Abstract Details

Purpose:

Macular oedema may present following cataract surgery and can result in both visual acuity reduction and distortion of central vision. The incidence of macular oedema varies with surgery, intraoperative complications and pre-existing risk factors. This review aims to evaluate existing evidence supporting the prophylactic use of topical NSAIDs either in addition to, or instead of, topical steroids postoperatively

Setting:

928 records were identified through database searching, of which 34 parallel group randomised controlled trials over 14 countries were included in the meta-analysis. There was an estimate of 5532 people (5608 eyes) enrolled in total.

Methods:

We included all parallel grouped quasi-RCTs comparing eyes with and without prophylactic NSAIDs. Outcome measures were post-operative visual outcomes, quality of life or patient satisfaction as well as change in central retinal thickness. We also included adverse effects and economic evaluation reported. A search was performed across multiple electronic databases. Investigators were contacted for further information as required. We also searched reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. Each trial was assessed independently by two authors utilising a form developed by the Cochrane Eyes and Vision Group.

Results:

There was low-certainty evidence that people receiving topical NSAIDs in combination with steroids may have a lower risk of poor vision due to macular oedema at three months (RR 0.40, 95% CI 0.27-0.61; eyes = 1360; studies = 5; I2 = 5%). There was inconsistent evidence on central retinal thickness at three months(I2 = 87%). Results ranged from -30.9 microns in favour of NSAIDs plus steroids to 7.44 microns in favour of steroids alone. Quality of life was only reported in one study but only commented on lack of differences between groups. Burning or stinging was most notable.

Conclusions:

This systematic review represents the most comprehensive review of the literature to date. Using topical NSAIDs may reduce the risk of developing macular oedema after cataract surgery, although it is possible that current estimates as to the size of this reduction are exaggerated due to selective non-reporting of negative studies. It is unclear the extent to which this reduction has an impact on the visual function and quality of life of patients. There is little evidence to suggest any important effect on vision after surgery.

Financial Disclosure:

NONE

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