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Brandon Baartman, Richard Gans, Jeffrey Goshe; Prednisolone vs Dexamethasone for prophylaxis of pseudophakic cystoid macular edema. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1322.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this review was to compare the rate of pseudophakic cystoid macular edema following cataract surgery in patients receiving prednisolone versus dexamethasone ophthalmic suspension.
The study was a retrospective chart review of cataract surgeries performed at the Cleveland Clinic between January 1, 2014 and June 31, 2014. Reviewable charts had to indicate the topical steroid used and whether or not an NSAID was used after surgery. Excluded from analyses were those patients having combination procedures or those that received an anti-VEGF or intraocular steroid injection within 1 month preceding surgery, patients receiving a topical steroid other than prednisolone or dexamethasone, those developing acute post-operative endophthalmitis, and those patients not demonstrating at least three months of follow up. Pseudophakic cystoid macular edema was defined as new or worsening macular edema demonstrated by OCT within the first 3 months following cataract extraction.
In total, 1835 patient charts met inclusion criteria for review. After exclusions, 1412 patient charts were included in the analysis, 959 of which were treated with prednisolone and 453 treated with dexamethasone. Patient characteristics similar between the two groups. The incidence of PCME in patients receiving prednisolone or dexamethasone alone was nearly identical at 4.21% and 4.23%, respectively (p=0.987), while those that were treated with dexamethasone/NSAID had a higher rate of PCME compared to those treated with prednisolone/NSAID (14.8% vs 3.6%, p=0.01); however, the gross discrepancy in sample size (27 compared to 222, respectively) likely contributed to this result. Overall, incidence of PCME in both study groups (steroid with or without NSAID) was similar, with a rate of 4.1% in patients treated with prednisolone versus 4.9% in patients treated with dexamethasone (p = 0.5).
There is no significant difference in the rate of pseudophakic cystoid macular edema when either prednisolone acetate or dexamethasone sodium phosphate are used prophylactically after cataract surgery. The results of this study importantly show the noninferiority of using a less expensive prophylactic agent for routine cataract surgeries, which, given the high volume of surgeries performed, could result in a great deal of cost savings and reduce the burden of healthcare costs.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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