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Adam G. Chun; Comparison Of Incidence Of Cystoid Macular Edema Following Nd: YAG Capsulotomy In Postoperative Treatment With Topical Steroids Versus Non-steroidal Anti-inflammatory Drugs. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4516.
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To determine if there is difference in the incidence of development of cystoid macular edema following Nd:YAG capsulotomy with postoperative treatment using topical steroids versus topical non-steroidal anti-inflammatory drugs (NSAIDs).
A retrospective study was conducted on 66 eyes of 57 patients that underwent Nd:YAG capsulotomy at one surgical center over a period of one year. All cases were performed by one of three resident surgeons. Prior to Nd:YAG capsulotomy, all patients were subjected to a through slit lamp biomicroscopic examination preoperatively. Following Nd:YAG capsulotomy, patients were started on one of three treatment regimes: topical steroids, NSAIDs (diclofenac or ketorolac) or a combination of steroids and NSAIDs. All medications were prescribed four times a day for 5 days postoperatively. Patients were then re-examined at 4 weeks and 3 months post-operatively. Each exam consisted of measuring of best corrected visual acuity followed by dilated fundus exam. During each dilated exam there was monitoring for development of cystoid macular edema.
There were 31 patients in cohort 1 which received only topical steroids in the immediate post-operative period. Cohort 2 received only NSAIDs which consisted of 21 patients and cohort 3 received combination therapy which had 14 patients. There were 5 patients that developed cystoid macular edema in the postoperative period. Cohort 1 had 3 cases of CME which accounted for 9.6% of patients within this cohort. Cohort 2 had no reported cases of CME. Cohort 3 had 2 cases of CME which accounted for 14.3% of patients within the cohort. Cohorts 1, 2 and 3 had a preoperative mean logMAR BCVA of 0.47, 0.44 and 0.64 respectively. Postoperative mean logMAR BCVA of 0.28, 0.20, and 0.43 respectively.
There is currently no defined standard of care in the immediate postoperative period after Nd:YAG capsulotomy. Topical steroids and NSAIDs are commonly prescribed in the attempt to prevent cystoid macular edema and postoperative inflammation. All cases of CME were seen in patients that had received topical steroids while no patients on monotherapy with NSAIDs developed CME. NSAIDs directly block the cyclooxygenase enzyme and ultimately decrease prostaglandin synthesis which is thought to be the cause of CME. Those in the NSAID only group had a small but significant improvement to their BCVA over the other two cohorts. Based in this study, NSAIDs may be the preferred postoperative treatment regime following Nd:YAG capsulotomy in the prevention of CME and improved BCVA.
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