Impact Of Postoperative Topical Nsaids On The Incidence Of Cystoid Macular Edema After Endothelial Keratoplasty
Published 2026 - 44th Congress of the ESCRS
Reference: FP14.04 | Type: Free paper | DOI: 10.82333/shw7-sa24
Authors: Dr Chiara Centini* 1 , Dr Caterina Sarnicola 1 , Dr Enrica Sarnicola 2 , Dr Vincenzo Sarnicola 1
1Ambulatorio di Chirurgia Oculare Santa Lucia,Grosseto,Italy;Clinica degli occhi Sarnicola,Grosseto,Italy, 2Ambulatorio di Chirurgia Oculare Santa Lucia,Grosseto,Italy;Clinica degli occhi Sarnicola,Grosseto,Italy;Università degli studi di Salerno,Salerno,Italy
Purpose
Cystoid macular edema (CME) is not uncommon after endothelial keratoplasty, with a reported incidence ranging from 4.8% to 13.7% across studies, and may compromise visual recovery. This study aimed to compare the incidence of CME after endothelial keratoplasty (DSAEK or DMEK) in eyes receiving postoperative topical non-steroidal anti-inflammatory drugs (NSAIDs) versus no NSAID prophylaxis.
Setting
Single referral center. All corneal transplants were performed by a single surgeon. Follow-up included standardized examinations and OCT imaging.
Methods
Retrospective single-center study including 687 eyes undergoing endothelial keratoplasty (DSAEK or DMEK). Eyes were divided into two groups: non-NSAID group (2009-2016) received standard postoperative corticosteroids and antibiotics regimen without NSAIDs; NSAID group (2017-2022) received topical NSAIDs starting 10 days postoperatively for 4 weeks in addition to the standard regimen. Eyes with prior macular edema or intraocular surgery within 2 months were excluded. Best corrected visual acuity (BCVA) and central macular thickness using OCT were assessed preoperatively and up to 6 months after surgery. Age, diabetes mellitus, axial length, rebubbling rate, transplant type and previous surgery were analyzed as potential risk factors.
Results
687 eyes undergoing endothelial keratoplasty (DSAEK or DMEK) were evaluated. The non-NSAID group included 381 eyes, while the NSAID group included 306 eyes. During the follow-up period, CME occurred in 45 of 381 eyes (11.8%) in the non-NSAID group compared to 8 of 306 eyes (2.6%) in the NSAID group (Fisher’s exact test, p < 0.00001). Topical NSAID use was associated with a significantly reduced risk of CME (RR ≈ 0.22). All CME resolved with appropriate therapy. No NSAID-related adverse events were observed during the follow-up period.
Conclusions
Postoperative topical NSAIDs significantly reduced CME incidence after endothelial keratoplasty (2.6% vs 11.8%). Adjunctive NSAID prophylaxis may represent a simple and effective preventive strategy against CME after DSAEK/DMEK.