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EW CATARACT 35 July 2017 however, that for those without risk factors, using the drug made no difference in preventing PCME. For those who did have risk factors, it made a large difference. "With contralateral PCME, there was almost a 20-times increased risk of PCME in the fellow eye if we did not use the NSAID," Dr. McCafferty said. The risk was 13 times for those with diabetic retinopathy or retinal vein occlusion, about eight times for those with a macular hole, and about six times for those with an epiretinal membrane. "Interest- ingly, we found no difference with prostaglandin (use)," he said, adding that there was a large retrospective study that also concluded that pros- taglandin use does not increase the incidence of PCME, with which they were in agreement. Clinical implications From a clinical perspective, a general ophthalmologist who uses NSAIDs with all patients will see some benefit, according to Dr. McCafferty. However, if the goal was to target PCME, physicians could tailor their NSAID use to just those patients who have risk factors, he continued. "That would be a savings to the patients and to the whole process of cataract surgery," he said. "I have changed my own practice according- ly." For those patients who he thinks may also have some postoperative pain, he will use the NSAID adjunc- tively in addition to considering the prevention of PCME. "But otherwise I just use it for those patients who have risk factors, which is about 30% of my patients," he said. Overall, Dr. McCafferty views this as a tool for general ophthal- mologists to enable them to more efficaciously use topical nonsteroid- als in their patients. "Also, they can feel some comfort that in a certain subset of patients, they do not have to use them to prevent this specific problem," he concluded. EW Reference 1. McCafferty S, et al. Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol. 2017;17:16. Editors' note: Dr. McCafferty has no financial interests related to his comments. Contact information McCafferty: sjmccafferty66@hotmail.com The Most Versatile Glaucoma Treatment in Ophthalmology Endoscopic CycloPhotocoagulation (ECP) • Mild, moderate and advanced glaucomas • Stand-alone or combined with Phaco and MIGS • Plateau Iris and other novel uses Call your local sales rep or customer service at +44 (0) 1865 601256 1-866-906-8080 beaver-visitec.com The Most Versatile Glaucoma Treatment in Ophthalmology "ECP is an ideal way to address moderately controlled glaucoma and cataract in one procedure." — Mr. Philip Bloom MBChB, FRCS(Ed), FRCOphth Western Eye Hospital Hillingdon Hospital London, UK "ECP-Plus is an e ective treatment for refractory and ultra refractory glaucoma. Our 2 year data shows outstanding sustained IOP lowering and medication reduction."* — Brian Francis, MD, MS Doheny Eye Institute Los Angeles, CA USA "Combining ECP with a variety of other MIGS procedures allows me to o er a balanced therapy that is tailored to each patient." — Nathan Radcliffe, MD Coney Island Hospital NYU Langone Medical Center New York, NY USA Beaver-Visitec International 85c Park Drive, Milton Park, Abingdon, Oxfordshire, OX14 4RY, UK *Tan, J.C.H., Francis, B.A., Noecker, R., Uram, M., et. al. Endoscopic Cyclophotocoagulation and Pars Plana Ablation (ECP-Plus) to Treat Refractory Glaucoma. J. Glaucoma, May 14, 2015. doi:10.1097/IJG. 278

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