Eyeworld

21 EW NEWS & OPINION July 2018 adding that unfortunately, since the database doesn't have a code for whether the surgery was complicat- ed or not, investigators were unable to explore this. Yet another hypothesis is that it is the preservative, as the two eye drops have the same preservative, BAK, in common, Dr. Mikelberg said, adding, however, that he thinks this is far less likely. He hopes that practitioners come away from the study with the realization that the use of a prostaglandin analog after cataract surgery is no riskier than a beta blocker. "The take-home message is that the use of a beta blocker or prostaglandin analog in the context of a patient who has had cataract surgery somewhat increases the risk of developing CME," he said. "The risk seems to be equal whether you use a beta blocker or a prostaglandin analog." Dr. Mikelberg pointed out that there is a caveat to the study. "The strength of this study is the 150 million patients in the database," he said. "The strength of this enormous cohort is that you could pull out sta- tistically significant results because of the sheer power of such a large database." But the flip side is be- cause of the sheer power, you could pull out things that while statistical- ly significant, may not be clinically significant, he noted, adding that in this case they're not recommend- ing that patients undergo cataract surgery in any different way. In addition, these database studies are detecting significant associations but not causations. This could mean that the asso- ciation between these medications and CME found here may not have anything to do with the prostaglan- din analogs or the beta blockers themselves, Dr. Mikelberg noted, adding that a randomized trial would be needed to prove causation. If they had access to another data- base that stated whether the cataract surgery was complicated, it might also be possible to delve into this further. "That's not coded, so I don't see how we can do that," Dr. Mikel- berg concluded. EW Contact information Mikelberg: frederick.mikelberg@ubc.ca Reference 1. Wendel C, et al. Association of postoperative topical prostaglandin analog or beta-blocker use and incidence of pseudophakic cystoid macular edema. J Glaucoma. 2018;27:402– 406. Editors' note: Dr. Mikelberg has no financial interests related to his comments. Surgical gonio prism with handle • Single piece design – no risk of instrument failure Single mirror lens with handle • Allows patient's eye and surgeon's microscope to be perpendicular Left hand and right hand handle options Scan to view a MIGS surgery video utilizing the surgical gonio prism 800-225-1195 • info@katena.com • www.katena.com Contact us now to arrange a no-risk evaluation MKT-0078-03/2016 These lenses: • Feature vaulted bottom for instrument access • Eliminate the need for post-operative sterilization • Are a Joint Commission accepted replacement for reusable lenses Single use surgical lenses for MIGS Get a better view of the angle

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