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Purpose: To describe the effect of routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of postoperative macular edema (PME) after cataract surgery. The role of diabetic retinopathy on the relationship between NSAID use and PME was further analyzed., Design: Retrospective matched cohort study., Methods: Patients undergoing cataract surgery between January 2007 and June 2014 were included in this study. A total of 108 093 Kaiser Permanente Southern California patients underwent cataract surgery and 89 731 met inclusion criteria. Cataract surgery patients who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only. The main outcome measure was the diagnosis of macular edema within 90 days of cataract surgery., Results: A prescription for an NSAID was filled by 56.4% of patients. The prevalence of PME was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs. The number needed to treat was 320 patients to prevent 1 case of PME. A matched cohort analysis was performed to account for confounders. NSAID use was associated with a lower incidence of PME in patients without diabetes [relative risk (RR) 0.68, 95% confidence interval (CI) 0.58-0.72] and diabetics without retinopathy (RR 0.51, 95% CI 0.32-0.82). NSAID use was not associated with a change in the incidence of PME among patients with diabetic retinopathy (RR 1.06, 95% 0.81-1.38)., Conclusion: Topical NSAIDs were associated with a modest reduction of PME incidence in patients undergoing cataract surgery; however, this relationship was not seen among those with diabetic retinopathy. The risk for PME is low and the number of patients benefiting from treatment is small., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME)., Design: Single-center comparative clinical study with historical controls., Setting: Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year., Patients: Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. Inclusion Criterion: Triple-DMEK surgery., Exclusion Criteria: Prior retinal surgery, history of prior CME., Interventions: Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral-domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery., Main Outcome Measure: Development of CME detected by macular SD OCT during 6 months postoperatively., Results: Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently (P = .003). Apart from the topical steroids during the first week, medical treatment was identical in both groups., Conclusions: Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery., Design: Systematic review and meta-analysis., Methods: setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs)., Study Population: RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabetic patients., Observation Procedures: Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria., Main Outcome Measures: Odds of developing CME within 3 months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3 months postoperatively, as compared to baseline., Results: Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03-0.37) and mixed populations (OR 0.05; 95% CI 0.02-0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10-0.44) and diabetic patients (OR 0.17; 95% CI 0.05-0.50). Intravitreal corticosteroid or anti-vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects., Conclusions: Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic and diabetic patients, as compared to topical corticosteroids., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To compare the postoperative macular thickness changes using optical coherence tomography (OCT) in eyes that underwent deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP)., Design: Prospective, nonrandomized clinical trial., Methods: Sixty eyes of 60 patients (32 male, 28 female) with keratoconus who underwent corneal transplant surgery in an institutional setting were included in the study. Thirty eyes underwent DALK and 30 eyes underwent PKP. All eyes underwent corrected visual acuity (CVA) measurement and macular thickness measurement using spectral-domain OCT preoperatively, and 1 week, 1 month, 3 months, and 6 months postoperatively. The main outcome measures were CVA and macular thickness., Results: The DALK group had significantly better mean CVA than that of the PKP group at 1-month (P < .001), 3-month (P = .002), and 6-month (P = .040) follow-ups. The mean macular thickness significantly increased at 1 week after PKP surgery, remained stable at 1-month follow-up, and decreased at 3- and 6-month follow-ups. On the other hand, the mean macular thickness remained stable during 6 months after DALK. Although there was no significant difference between groups preoperatively (P = .970) and at 6-month follow-up (P = .339), the PKP group had significantly higher mean macular thickness than that of the DALK group at 1-week (P < .001), 1-month (P < .001), and 3-month (P = .005) follow-ups., Conclusion: Although mean macular thickness increases and peaks around 1 month and returns back to normal levels at 6 months after PKP surgery, it does not change after DALK., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To evaluate whether adding perioperative topical ketorolac tromethamine 0.4% improves cataract surgery outcomes relative to topical steroids alone in patients without known risk factors for cystoid macular edema (CME)., Design: Prospective, randomized, investigator-masked, multicenter clinical trial., Methods: Patients scheduled to undergo phacoemulsification and with no recognized CME risks (diabetic retinopathy, retinal vascular disease, or macular abnormality) were randomized to receive either prednisolone acetate 1% 4 times daily (QID) alone (steroid group; n = 278) or prednisolone 1% QID plus ketorolac 0.4% QID (ketorolac/steroid group; n = 268) for approximately four weeks postoperatively. In the ketorolac/steroid group, patients also received topical ketorolac 0.4% QID for three days preoperatively. In both groups, patients received four doses of ketorolac 0.4% one hour before surgery. Patients with capsular disruption or vitreous loss intraoperatively were exited from the study. Outcome measures included CME incidence, retinal thickness as measured by optical coherence tomography (OCT), best-corrected visual acuity, and contrast sensitivity., Results: No patients in the ketorolac/steroid group and five patients in the steroid group had clinically apparent CME (P = .032). Based on OCT, no ketorolac/steroid patient had definite or probable CME, compared with six steroid patients (2.4%; P = .018). In the ketorolac/steroid group, mean retinal thickening was less (3.9 microm vs 9.6 microm; P = .003), and fewer patients had retinal thickening of more than 10 microm as compared with the steroid group (26% vs 51%; P < .001)., Conclusions: This study suggests that adding perioperative ketorolac to postoperative prednisolone significantly reduces the incidences of CME and macular thickening in cataract surgery patients already at low risk for this condition.

Purpose: To assess the evidence that pars plana vitrectomy (PPV) is useful in improving vision, reducing disease activity, or ameliorating cystoid macular edema (CME) in patients with uveitis., Design: Review of the literature., Methods: A Medline search was conducted for relevant articles published in English, German, or French. Articles were analyzed for content and evidence level., Results: A total of 44 interventional case series published between 1981 and 2005 were identified that included 1575 patients (1762 eyes). Evidence level was grade CII-3 indicating possibly improved clinical outcomes with fair or poor evidence. The average age of patients was 36 years with a median duration of uveitis before surgery of 48 months and a median follow-up of 1.9 years. Intermediate uveitis was present in 841 eyes. Cystoid macular edema and cataract were common co-morbidities, and there were large numbers of additional surgical procedures. Visual outcomes in 39 articles were stated as improved in 708 eyes (68%), unchanged in 202 eyes (20%), and worsened in 124 eyes (12%). Reduction in systemic medication following PPV was reported in 25 studies. The median reported percentage of patients per study with CME was 36% preoperatively and 18% postoperatively., Conclusions: Based on the evidence in the literature, PPV is possibly relevant to the outcomes of improving vision and reducing inflammation and CME. Randomized, controlled, collaborative trials or hypothesis-based case series with precise outcome measures that incorporate control groups would improve the quality of evidence supporting PPV as an adjunct to the medical treatment of uveitis.

Purpose: To describe the incidence of vision loss and of ocular complications attributable to birdshot retinochoroidopathy and to describe the association between therapy and the incidence thereof., Design: Retrospective cohort study., Setting: Single-center, academic practice., Study Population: Forty patients with birdshot retinochoroidopathy were evaluated from January 1984 through March 2004., Observation Procedure: Demographic and clinical information on patients diagnosed with birdshot retinochoroidopathy was collected., Main Outcome Measures: Visual acuity and visual field loss; ocular complications including cystoid macular edema (CME)., Results: In affected eyes, the frequencies of vision loss to 20/50 or worse and to 20/200 or worse and of CME at presentation were 33%, 13%, and 20%, respectively. Patients who presented with a duration of disease of > or = 30 months had higher frequencies of visual impairment to 20/50 or worse (68% vs 32%; P = .004) and to 20/200 or worse (32% vs 9%; P = .01), and had a higher frequency of CME (38% vs 14%; P = .02) than patients who presented with a duration of disease <30 months. The incidence rates on follow-up for vision loss to 20/50 or worse and to 20/200 or worse were 13% and 4% per eye-year (EY), respectively. The incidence of CME was 10%/EY. Use of immunosuppressive drug therapy was associated with a reduced risk of developing CME (relative risk = 0.17; 95% confidence interval: 0.05, 0.64; P = .009)., Conclusions: Birdshot retinochoroidopathy is a progressive disease with the potential for visual impairment. Patients who present at a later date after the onset of disease were more likely to have vision impairment and CME. Use of long-term immunosuppressive therapy may reduce the risk of CME.

Purpose: To review cystoid macular edema in relationship with ocular hypotensive lipids and to present recommendations for use in eyes at increased risk of cystoid macular edema., Design: Focused literature review and authors' clinical experience., Methods: Cystoid macular edema in association with cataract surgery, epinephrine therapy, and ocular hypotensive lipid therapy is reviewed., Results: Cystoid macular edema may be associated with a variety of therapeutic interventions, predominantly in eyes at increased risk with open or absent posterior lens capsule and ocular inflammation. Based primarily on experience with latanoprost, the association between ocular hypotensive lipids and cystoid macular edema, even in high-risk eyes, although present, appears to be low., Conclusions: Considering the low incidence of cystoid macular edema associated with latanoprost therapy, the authors feel that after maximal tolerable medical therapy and with proper precautions, the use of an ocular hypotensive lipid is an acceptable alternative to filtration surgery in high-risk eyes.