Alqahtani Abdullah S, Hersi Reem M, Homsi Jumana J, Alamoudi Loujen O, Alghamdi Sara, Alrajhi Rawan K, AlJehani Reham A
Department of Surgery, Division of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Int J Retina Vitreous. 2024 Oct 10;10(1):72. doi: 10.1186/s40942-024-00588-8.
Pseudophakic cystoid macular edema (PCME) is a known complication of cataract surgery that contributes to decreased visual acuity. Mechanical manipulation associated with the release of inflammatory mediators is the leading hypothesis for PCME. To date, no standardized prophylactic protocol has been established to effectively reduce the incidence of PCME. This study assessed the efficacy and safety of nonsteroidal anti-inflammatory drops (NSAIDs) and corticosteroids for the prevention of PCME.
We searched the following databases MEDLINE, EMBASE, and Cochrane Central. Register of Controlled Trials and included randomized controlled trials (RCTs) that studied the efficacy of NSAID vs. placebo, NSAID vs. steroid, or NSAID + steroid vs. placebo, reporting the incidence of PCME, macular thickness, and best-corrected visual acuity. The risk ratio (RR) with a 95% confidence interval (CI) and a random-effects model was used. The risk of bias was assessed using the revised Cochrane risk-of-bias tool.
A total of 18 RCTs were included in this study (n = 2959). Nine RCT showed low risk of bias, 7 RCT showed unclear risk of bias, and 2 RCT had high risk of bias. The incidence of cystoid macular edema among patients treated with NSAIDs was significantly lower (RR = 0.33, P < 0.001). Subgroup analysis revealed a statistically significant low risk of edema among patients treated with NSAIDs alone (P < 0.001) compared to others. NSAIDs were associated with significantly low mean corrected visual acuity values using LogMar (P < 0.001).
NSAID alone or in combination with steroids showed its efficacy in reducing the incidence of PCME post-operatively. Future double-blind randomized controlled trials are required to standardize the protocol for different patient population.
人工晶状体眼黄斑囊样水肿（PCME）是白内障手术已知的并发症，可导致视力下降。与炎症介质释放相关的机械操作是PCME的主要假说。迄今为止，尚未建立有效降低PCME发生率的标准化预防方案。本研究评估了非甾体类抗炎滴眼液（NSAIDs）和皮质类固醇预防PCME的有效性和安全性。
我们检索了以下数据库：MEDLINE、EMBASE和Cochrane中心对照试验注册库，并纳入了研究NSAIDs与安慰剂、NSAIDs与类固醇或NSAIDs+类固醇与安慰剂疗效的随机对照试验（RCTs），报告PCME的发生率、黄斑厚度和最佳矫正视力。使用具有95%置信区间（CI）的风险比（RR）和随机效应模型。使用修订的Cochrane偏倚风险工具评估偏倚风险。
本研究共纳入18项RCTs（n=2959）。9项RCT显示低偏倚风险，7项RCT显示偏倚风险不明确，2项RCT具有高偏倚风险。接受NSAIDs治疗的患者中黄斑囊样水肿的发生率显著更低（RR=0.33，P<0.001）。亚组分析显示，与其他患者相比，单独接受NSAIDs治疗的患者发生水肿的风险在统计学上显著更低（P<0.001）。使用LogMar量表时，NSAIDs与显著更低的平均矫正视力值相关（P<0.001）。
单独使用NSAIDs或与类固醇联合使用在降低术后PCME的发生率方面显示出疗效。未来需要进行双盲随机对照试验，以规范针对不同患者群体的方案。
