Effect of prophylactic nonsteroidal antiinflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery.

Author(s): Almeida DR, Johnson D, Hollands H, Smallman D, Baxter S, Eng KT, Kratky V, Ten Hove MW, Sharma S, El-Defrawy S

Affiliation(s): From the Department of Ophthalmology (Almeida, Johnson, Hollands, Smallman, Baxter, Kratky, ten Hove, Sharma, El-Defrawy), Queen's University, Hotel Dieu Hospital, Kingston, and the Department of Ophthalmology and Vision Sciences (Eng), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Publication date & source: 2008-01, J Cataract Refract Surg., 34(1):64-69.

PURPOSE: To evaluate the efficacy of prophylactic administration of the topical nonsteroidal antiinflammatory drug (NSAID) ketorolac tromethamine 0.5% on acute (within 4 weeks of surgery) cystoid macular edema (CME) and total macular volume (TMV) in patients having phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada. METHODS: This open-label nonmasked randomized (random number assignment) study comprised 106 eyes of 98 patients. Exclusion criteria included hypersensitivity to the NSAID drug class, aspirin/NSAID-induced asthma, and pregnancy in the third trimester. Ketorolac tromethamine 0.5% was administered starting 2 days before surgery and for 29 days after surgery for a total of 31 days. The outcome measure was macular swelling, which was quantified by the optical coherence tomography. RESULTS: At 1 month, there was a statistically significant difference in TMV between the control group (0.4420 mm(3)) and the ketorolac group (0.2392 mm(3)), with the ketorolac group having 45.8% less macular swelling (P = .009). Multiple linear regression with backward selection indicated a 44.3% (P = .013) and 46.1% (P = .030) reduction in macular swelling in the ketorolac group at 1 week and 1 month, respectively. CONCLUSION: Used prophylactically after cataract surgery, ketorolac 0.5% was efficacious in decreasing postoperative macular edema.