Eyeworld

63 EW RESIDENTS by Arthika Chandramohan, MD, Laura Huang, MD, Michele Lee, MD, Cassie Ludwig, MD, Matthew Powers, MD, Ryan Shields, MD, and Douglas Fredrick, MD to once-daily nepafenac 0.3% in one eye and artificial tear substitute (ATS) in the fellow eye. The dosing began 2 days prior to surgery and continued for 5 weeks. All patients had spectral domain optical coher- ence tomography (SD-OCT) scans performed that measured central subfield thickness (CST, μm) (central 1-mm subfield), and total macular volume (TMV, mm 3 ) preoperatively and at 1, 5, and 12 weeks of fol- low-up. Follow-up results at 5 weeks postoperatively demonstrated that there was a statistically signifi- cant difference in favor of using nepafenac 0.3% based on mean central subfield thickness (CST) and total macular volume (TMV) as measured by OCT. None of the tion with steroids may decrease risk of CME, though not all comparisons met statistical significance. 9 In the April issue of the Journal of Cataract & Refractive Surgery, two prospective randomized studies in- vestigated the role of topical NSAIDs after cataract surgery. In "Intrain- dividual comparison of nepafenac 0.3% for the prevention of macular edema after phacoemulsification: Prospective randomized study," Tzelikis et al. conducted a random- ized, prospective, intraindividual comparative study assessing the effect of topical nepafenac 0.3% ver- sus placebo in the prophylaxis of ME following cataract extraction. One hundred and three patients with bilateral visually significant cataracts had phacoemulsification cataract surgery performed in each eye. All patients were randomly allocated W ith the advent of modern techniques, cataract surgery has become a safe and efficient procedure with excellent visual outcomes in the majority of cases. However, postoperative macular edema (ME) still remains a potential complica- tion and barrier to optimal visual acuity. 1 The prevalence of postop- erative ME ranges from 0.1 to 4%, with the highest risk of occurrence 4 to 6 weeks after surgery. 2–3 While the exact pathophysiology of ME is unclear, there is a general under- standing that postoperative inflam- matory cascade activation leads to generalized vascular permeability, with disruption of the blood/retina barrier, and subsequent accumula- tion of intraretinal fluid. 4 Given the likely activation of the arachidonic acid pathway, topical non-steroidal anti-inflammatory (NSAID) agents Topical NSAIDs in low risk cataract surgery patients lack a clear benefit to warrant changes in current practice patterns April 2018 Douglas Fredrick, MD, residency program director, Byers Eye Institute, Stanford University Whether we should routinely prescribe topical NSAIDs for all of our cataract patients has long been debated. I asked the Stanford residents to review two new studies that appear in the April issue of JCRS. —David F. Chang, MD, EyeWorld journal club editor have been used to reduce the post- operative incidence of ME. However, the use of topical NSAIDs as evidence-based adjuvant prophylaxis has not found consen- sus in either individual or com- mittee-level practice patterns. 1,5 To date, there has been no high quality evidence demonstrating clinically significant improvement in the incidence or visual effect of post- operative ME. 1,6 Recent systematic reviews and meta-analyses suggest that NSAIDs may have some role in preventing ME, although none have demonstrated a benefit in postop- erative visual acuity. 6–9 In addition, the role and effect of postoperative steroids complicates our under- standing of any unique or synergis- tic effect of adjuvant NSAID use. A recent systematic review suggested both NSAIDs alone and in conjunc- continued on page 64 Cassie Ludwig, MD Byers Eye Institute, Stanford University residents Arthika Chandramohan, MD Laura Huang, MD Michele Lee, MD Matthew Powers, MD Ryan Shields, MD

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