Cystoid Macular Edema, NSAIDS And Cataracts

Cystoid Macular Edema is a swelling in the central most part of the retina creating small cyst like lesions. It may occur for a number of reasons, but I will concentrate on the incidence occurring following cataract surgery.

The standard of care has changed greatly over the years with cataract surgery; attempting to reduce or eliminate post surgical complications. In years past, antibiotics were employed both pre and post operative to prevent infections. That has not changed, although the antibiotics have. Likewise steroid use has been used to reduce inflammation on, and in the eye. In doing so healing improves, the patient has reduced pain, and there is less likelihood of post surgical scarring.

Years ago, if there was an increased pressure in the eye following the procedure, Propine was used to reduce it. Frequently, these patients developed Cystoid Macular Edema(CME). CME can reduce the vision dramatically, and requires aggressive treatment to prevent damage. When it was determined that it was the Propine that caused the CME, it was stopped immediately. Over time, surgeons have tried to prevent CME pharmaceutically and thus reduce a serious complication.

The answer turned out to be Non Steroidal Anti-inflammatory Drugs(NSAIDs). The standard of care in cataract surgery now includes the use of these NSAIDs. At first, just those individuals with Uveitis, diabetes or retinal vascular conditions were prescribed these great drugs. Now, ALL cataract patients are told to use them. Since CME is the most common cause of visual decline in uncomplicated cataract surgery, it is important to prevent it. NSAIDs inhibit prostaglandin synthesis which is responsible for most of the post surgical inflammation. Therefore, preventing the prostaglandins will increase comfort, prevent miosis(small pupils) and avoid CME. The usual use for NSAIDs is 2-3 days prior to surgery and then at least a month post surgically.

The most commonly used NSAIDs are Acular, Xibrom, which is frequently used for pain management, and Nevanac. These new drugs dramatically improve surgical results while reducing patient discomfort.