Increased Frequency of Topical Steroids Provides Benefit in Treatment of Postsurgical Cystoid Macular Edema

Abstract

Purpose : To compare standard and frequent administration of topical steroids in the treatment of postsurgical cystoid macular edema (CME).

Methods : Patients with postsurgical CME were stratified into post-cataract and post-other surgery and randomized to ketorolac qid + 1% prednisolone acetate (PA) qid or every hour while awake (q1hWA). The primary endpoint was the mean change from baseline best corrected visual acuity (BCVA) at week 12 after which patients randomized to PA qid were changed to PA q1hWA if edema was not resolved. Secondary endpoints were the mean change from baseline central subfield thickness and IOP at week 12 and mean change from week 12 BCVA and CST at week 24.

Results : Twenty-two patients (13 post-cataract and 9 post-other surgery) were randomized to PA q1hWA and twenty patients (12 post-cataract and 8 post-other surgery) to PA qid. At week 12, the change from baseline BCVA in the PA q1hWA group vs the PA qid group was 11.6 vs 8.5 (p=0.32). Subgroup analysis showed PA q1hWA vs PA qid of 10.6 vs 7.8 in the post-cataract group and 13.1 vs 9.4 in the post-other surgery group. The change from baseline CST at week 12 in the PA q1hWA group vs the PA qid group was -103.3 vs -60.6 (p=0.30). The mean change from baseline IOP was 1.7 vs 2.6 mmHg (p=0.52). Ten patients in the PA qid group with residual edema at week 12 were switched to PA q1hWA and at week 24, the mean changes from week 12 BCVA and CST were 5.0 letters (p=0.053) and -74.0 µm (p=0.047).

Conclusions : Our data suggest that patients with postsurgical CME should initially be treated with ketorolac and PA qid, but if edema does not resolve after 12 weeks, a switch to ketorolac qid and PA q1hWA may provide additional benefit.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.