Non-steroidal anti-inflammatory agents for treating cystoid macular edema following cataract surgery

• Published in: Cochrane database of systematic reviews 2022-12, Vol.12 (12), p.CD004239
• Main Authors: Wingert, Andreas M, Liu, Su-Hsun, Lin, John C, Sridhar, Jayanth
• Format: Article
• Language: English
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Cataract; Cataract - complications; Diclofenac - therapeutic use; Eyes & vision; Female; Humans; Ketorolac - therapeutic use; Macular Edema - drug therapy; Macular Edema - etiology; Male; Prednisolone - therapeutic use; Quality of Life; Retinal disease (including age-related macular degeneration)
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD004239.pub4

Cataract surgery is the most common ambulatory incisional surgery performed in the USA. Cystoid macular edema (CME), the accumulation of fluid in the central retina due to leakage from dilated capillaries, is the most common cause of vision impairment following cataract surgery. Acute CME, defined as CME of less than four months' duration, often resolves spontaneously. CME that persists for four months or longer is termed chronic CME. Non-steroidal anti-inflammatory drugs (NSAIDs) have been used to treat CME. This update adds new evidence and analyses to the previously published review. To examine the effectiveness of NSAIDs in the treatment of CME following cataract surgery. We searched the CENTRAL (2022, Issue 3); Ovid MEDLINE; Embase; PubMed; LILACS; mRCT (discontinued in 2014, last searched August 2011), ClinicalTrials.gov, and WHO ICTRP databases. We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 20 March 2022.   SELECTION CRITERIA: We included randomized controlled trials evaluating the effects of NSAIDs for CME following cataract surgery. Two review authors independently screened all titles and abstracts, reviewed full-text publications against eligibility criteria, independently extracted data from newly included trials and assessed risk of bias for each included trial. We contacted trial authors for clarification or to request missing information. We provided a narrative synthesis of all included trials and their results. For continuous and dichotomous outcomes, we separately performed pooled analysis and reported mean difference (MD) and risk ratio (RR) as well as the associated 95% confidence interval (CI) whenever feasible. Two review authors independently graded the overall certainty of the evidence for each outcome using the GRADE approach. We included nine trials with a total of 390 participants (393 eyes). Study participants' mean age was 72.2 years (interquartile range [IQR] 68.8 to 73.6) and 72% were women (IQR 69% to 74%). Three trials included participants with acute CME, and four included participants with chronic CME; the remaining two trials enrolled both participants with acute and chronic CME or participants with unknown CME duration. We assessed trials as having unclear (33%) or high risk of bias (67%). Visual improvement of two or more lines at the end of treatment  Data from one trial in participants with acute CME show no treatment effect of topica