Korean J Ophthalmol.  2017 Oct;31(5):394-401. 10.3341/kjo.2016.0109.

Additive Effect of Oral Steroid with Topical Nonsteroidal Anti-inflammatory Drug for Preventing Cystoid Macular Edema after Cataract Surgery in Patients with Epiretinal Membrane

• Kim S
• Kim MK
• Wee WR

• KMID: 2390282
• DOI: http://doi.org/10.3341/kjo.2016.0109

Abstract

PURPOSE
To investigate the additive effect of oral steroid with topical nonsteroidal anti-inflammatory drug (NSAID) on cystoid macular edema (CME) in patients with epiretinal membrane (ERM) after cataract surgery.
METHODS
Medical records of subjects who underwent uneventful cataract surgery (n = 1,349) were retrospectively reviewed; among these patients, those with pre-existing ERM (n = 81) were included. Patients were divided into two groups: one group had postoperative administration of oral steroid for 1 week (n = 45) and the other group did not have oral steroid administration (n = 36). Changes in macular thickness and incidence of CME were compared in both groups. Topical NSAIDs were administered in both groups for 1 month postoperatively. Definite CME and probable CME were defined by changes in retinal contour with or without cystoid changes. Change in central macular thickness of more than three standard deviations (≥90.17 µm) was defined as possible CME. Macular thickness was measured at 1 month after the operation by optical coherence tomography.
RESULTS
The incidence of definite, probable, and possible CME were 2.22%, 4.44%, and 8.89% with the use of steroid and 2.78%, 5.56%, and 8.33% without steroid, respectively (p = 0.694, p = 0.603, and p = 0.625), and regardless of treatment group, the incidences in these patients were higher compared to incidences in whole subjects (1.26%, 2.30%, and 4.32%; p = 0.048, p = 0.032, and p = 0.038, respectively). The differences in macular thickness were not statistically different between the two groups. Average changes of central foveal thickness in 3 mm and 6 mm zone were 29.29 µm, 35.93 µm, and 38.02 µm with the use of steroid and 32.25 µm, 44.08 µm, and 45.39 µm without steroid (p = 0.747, p = 0.148, and p = 0.077, respectively).
CONCLUSIONS
This study suggests that administration of oral steroid may not have a synergistic effect in reduction of CME and retinal thickness in patients with pre-existing ERM after cataract surgery, when topical NSAIDs are applied.

Keyword

Cataract; Epiretinal membrane; Macular edema; Oral steroid

MeSH Terms

Anti-Inflammatory Agents, Non-Steroidal
Cataract*
Epiretinal Membrane*
Humans
Incidence
Macular Edema*
Medical Records
Retinaldehyde
Retrospective Studies
Tomography, Optical Coherence
Anti-Inflammatory Agents, Non-Steroidal
Retinaldehyde

Figure

• 

  Fig. 1 The distribution of central macular thickness based on optical coherence tomography analysis is illustrated.

• 

  Fig. 2 (A-F) Optical coherence tomography images of cystoid macular edema (CME). (A,B) Preoperative and postoperative findings of definite CME. (C,D) Preoperative and postoperative findings of probable CME. (E,F) Preoperative and postoperative findings of possible CME.

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