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EW NEWS & OPINION February 2016 21 2. Shorstein NH, et al. Comparative effec- tiveness of three prophylactic strategies to prevent clinical macular edema after phacoemulsification surgery. Ophthalmology. 2015 Dec;122(12):2450–6. the odds of developing CME in non-diabetic and diabetic patients, as compared to corticosteroid use alone. "I don't vary my prophylaxis based upon a patient's diabetes comorbidity," said Neal Shorstein, MD, Kaiser Permanente, Walnut Creek, Calif. "A lot of studies in the literature look at different endpoints —clinically significant postoperative CME is a common endpoint. But there's a paucity of evidence in the literature that has closely looked at the final VA following different comparative prophylactic CME strategies." There are numerous smaller studies that suggest there's a benefit in higher-risk groups, but "with an incidence of only 1–2%, it's hard for me to feel confident that the addi- tional cost is justified," he said. What's needed, he said, is a "large cohort study that looks at dis- crete groups of patients, controlled for comorbidities, and final VA." Dr. Shorstein currently injects triamcin- olone under the conjunctiva, saying that the method compares favorably to topical prednisolone. "Subconjunctival triamcinolone injections are a means of eliminat- ing the patient compliance factor," he said. "A group of us also stopped prescribing topical antibiotic drops, largely eliminating postoperative drops altogether." In their analysis of more than 16,000 patients, 2 Dr. Shorstein said the study "did show an unexpected finding that adding topical NSAIDs to topical prednisolone reduces the incidence of visually significant CME by half." He found an overall incidence of CME of 0.73% (118 cases in 16,070 surgeries); VA was 20/40 or worse and CME was confirmed on OCT, Dr. Shorstein said. "It's a pretty low incidence for a problem that of- ten resolves spontaneously," he said. Another surprising finding was that race was associated with an increased risk of CME, with blacks having a higher risk, but Dr. Shorstein's group did not find an increased risk of postop CME in diabetics (although there was an in- creased risk in patients who under- went cataract surgery and had been coded with diabetic retinopathy before the surgery). EW References 1. Kim SJ, et al. Topical nonsteroidal anti-inflammatory drugs and cataract surgery: A report by the American Academy of Ophthalmology. Ophthalmology. 2015 Nov;122(11):2159–68. FORWARD. Direction. Force. Momentum. 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS A world-class institution grows By doing the right things And moving all of us forward. Editors' note: The physicians have no financial interests related to this article. Contact information Kim: flum@aao.org Shorstein: nshorstein@eyeonsight.org

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