Eyeworld

OCTOBER 2019 | EYEWORLD | 23 Weill Cornell residents, from left: Daniel Kornberg, MD, Alexander Dillon, MD, Geoffrey Rodriguez, MD, Mahmood Khan, MD, Stephanie Engelhard, MD, Christiana Gandy, MD, Michelle Sun, MD, Jason Chien, MD, Christina Grassi, MD continued on page 24 usual time course for the onset of PME, typi- cally 4–12 weeks after surgery, reaching a peak incidence 4–6 weeks postoperatively. 12 Lastly, patients included were also on treatment for at least 6 months with topical latanoprost 0.005% eye drops. There are several limitations of this study. As the authors acknowledged, the study size was not large enough to elicit a statistically significant difference in clinical PME between treatment arms, given its relatively low inci- dence rate. The use of potential confounding medications like acetazolamide (a treatment for PME) were not controlled for or matched between arms, and neither were use of iris ma- nipulators during surgery, which may increase inflammation and possibly PME as a result. The applicability of this study to practices that rou- tinely use topical NSAIDs pre- and postop may be limited, because NSAIDs were not routinely used in this study, and steroid use was more fre- quent than is typical (specifically betamethasone every 2 hours for 1 week followed by a taper). While investigators were blinded to pa- tients' treatment arms, patients were not (there was no use of a placebo control). One could argue that this could be of limited importance in determination of the primary endpoint, an objective anatomical measurement. That said, it could influence a more subjective measurement such as visual acuity. On that note, neither visual acuity (pre- or postop) or preoperative cataract grade were reported or controlled for between treatment arms. Furthermore, the primary endpoint, as well as the secondary outcome of significant CMT increase from baseline, are of only indirect clinical signifi- cance. That is, one may presumably have some unknown degree of CMT without experienc- ing a functional decline. A larger, double-blind- ed, placebo-controlled study with postop regimens that more closely mirror mainstream practice patterns explicitly reporting differen- tial functional outcomes may further inform cataract surgeons' perioperative management of patients on PGAs. Current evidence of a possible associa- tion between the development of PME after uncomplicated cataract surgery and the postop- erative use PGAs is sparse and often conflict- ing. Studies that support a potential causative 8. Yonekawa Y, et al. Pseudopha- kic cystoid macular edema. EyeWiki. https://eyewiki.aao.org/ Pseudophakic_Cystoid_Macular_ Edema_(Irvine-Gass_Syndrome). Accessed 8/14/2019. 9. Connor AJ, Fraser SG. Glauco- ma prescribing trends in England 2000 to 2012. Eye (Lond). 2014 Jul;28(7):863–869. 10. Tham Y, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040. Ophthalmology. 2014;121(11):2081–2090. 11. Gollogly HE, et al. Increas- ing incidence of cataract surgery: Population-based study. J Cataract Refract Surg. 2013;39(9):1383–1389. 12. Lally DR, Shah CP. Pseu- dophakic cystoid macular edema. Review of Ophthalmology. 2014. Accessed 8/14/2019. 13. Walkden A, et al. Pseudopha- kic cystoid macular edema and spectral-domain optical coher- ence tomography-detectable cen- tral macular thickness changes with perioperative prostaglandin analogs. J Cataract Refract Surg. 2017;43:1027–1030. 14. Yeh PC, Ramanathan S. Lata- noprost and clinically significant cystoid macular edema after uneventful phacoemulsification with intraocular lens implanta- tion. J Cataract Refract Surg. 2002;28:1814–1818.

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