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Cameron C. Johnson, Robert A. Rombola, II, Peter J. Krall; Clinical Outcomes at a VAMC after the Introduction of Universal NSAID Therapy Perioperatively in Cataract Patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6654.
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To determine whether the addition of ketorolac 0.4% to the perioperative regimen of cataract patients improves visual outcomes following uncomplicated surgery in patients with no pre-existing risk factors for cystoid macular edema (CME).
A retrospective chart review was conducted of all patients who underwent cataract surgery at the Malcolm Randall VA Medical Center in Gainesville, FL, one year prior to and one year following the institution of universal perioperative ketorolac use. Patients with surgical complications or pre-existing risk factors for CME were excluded. 157 patients who received perioperative ketorolac and 154 patients who did not were enrolled in the study. Demographic information and preoperative visual acuity were recorded, along with postoperative visual acuity at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months. Since patients had not been refracted at every time point, a "final visual acuity" was documented for the visit closest to 12 months at which the patient had been refracted. This visit was required to have occurred between 6 and 18 months post-operatively. The presence of CME on clinical exam and whether it was confirmed with ocular coherence tomography were recorded. Methods required to treat CME and visual acuity after CME resolution were also noted.
Average Log MAR visual acuities for NSAID and non-NSAID treated patients were +0.380 and +0.400 preoperatively (p=0.58), +0.240 and +0.268 at one day (p=0.39), +0.139 and +0.154 at one week (p=0.95), +0.090 and +0.099 at one month (p=0.96), +0.069 and +0.091 at 3 months (p=0.28), +0.064 and +0.076 at 6 months (p=0.46), +0.060 and +0.054 at 12 months (p=0.64), and +0.053 and +0.051 at the "final refracted visit" (p=0.85), respectively. There were three cases of CME detected (1.9%) among patients who received perioperative ketorolac and one case (0.6%) among patients who did not receive it (p=0.62). Two of these patients were treated successfully with topical prednisolone actetate 1% and ketorolac 0.4%. One patient required intravitreal triamcinolone injection. One patient was observed due to no decrease in visual acuity. Final visual acuity was 0.00 in two patients and +0.30 in two patients after resolution of their CME.
While it has been previously shown that perioperative treatment of cataract surgery patients with NSAIDs reduces angiographic CME, our study failed to show any significant improvement in visual outcomes at any time point with perioperative use of ketorolac 0.4%. We also did not demonstrate a significant difference in rates of clinically significant CME.
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