LOWERING CME

When it comes to prevention of pain and inflammation after cataract surgery, brandname products are preferred over their generics; it is better to use an NSAID in allcomers than in just high-risk patients; and routine use of a brand-name NSAID started two days preoperatively and continued for one month after surgery, is as or more effective than postoperative treatment with a corticosteroid alone. These are the conclusions of a retrospective study reported by Keith Walter MD, associate professor of ophthalmology, Wake Forest Baptist Medical Centre, Winston-Salem, NC, at the XXXI Congress of the ESCRS in Amsterdam.

That study included data from 5,380 eyes operated on by Dr Walter and two other colleagues between July 2007 and December 2012. Only 13 eyes operated on during the study were excluded from the analysis. All three surgeons used the same phacoemulsification machine and implanted the same IOL, but they used different anti-inflammatory medication regimens.

Three regimens, each prescribed by a different surgeon included a five-week tapering course of prednisolone acetate one per cent postoperatively with an NSAID (bromfenac 0.09 per cent BID, ketorolac tromethamine 0.5 per cent QID, or ketorolac tromethamine 0.4 per cent) given postoperatively for one month only to patients with a history of cystoid macular edema (CME) or otherwise considered at high risk. Two of the three groups were treated with all brand-name products (Pred Forte one per cent and either Acular 0.5 per cent or Xibrom 0.09 per cent). Generic prednisolone acetate one per cent and ketorolac tromethamine 0.4 per cent were allowed in the third group and received by 80 per cent of patients.

The fourth study group, representing a second cohort operated on by Dr Walter during the latter half of the study period, received treatment with brand-name Bromday (bromfenac 0.09 per cent) QD, started two days preoperatively and continued one month postoperatively. Charts were reviewed to identify eyes that developed OCTdiagnosed CME within one month after surgery. Dr Walter said OCT was not performed routinely, but only if a patient exhibited BCVA loss.

CME occurred among 0.09 per cent of 1,090 eyes treated with Bromday only, 0.44 per cent of 1,128 eyes treated with Pred ForteÂ}Xibrom, 0.9 per cent of 2,437 eyes in the Pred ForteÂ}Acular group, and 2.44 per cent of 725 eyes in the group where generic substitution was allowed. Statistical analyses showed the Bromday only group had a lower rate of CME compared with the Pred ForteÂ}Acular and the generic substitution groups.

“Steroids are a mainstay of anti-inflammatory treatment after cataract surgery, and NSAIDs are often added for greater efficacy. However, according to this study, once-daily treatment with brand-name bromfenac is as reliable as a combination regimen for controlling inflammation and suppressing CME rates,” said Dr Walter.

Keith Walter: kwalter@wakehealth.edu