Eyeworld

EW RESIDENTS 64 April 2018 patients in the nepafenac group developed ME, compared to four (3.57%) eyes in the control group. This difference was not statistically significant, although it highlighted a trend toward a greater incidence in the control group. There was no impact on visual acuity after 5 or 12 weeks of follow-up. This paper concluded that the use of nepafenac 0.3% to prevent an increase in mean CST and TMV and a decrease in the incidence of mac- ular edema is efficacious. However, the latter effect was not statistically significant. Further limitations in- clude the limited generalizability of this patient population, which did not include those with risk factors for CME. Additionally, change in visual acuity was the only measured effect of macular edema, while other visual metrics such as microperim- etry or contrast sensitivity were not evaluated. Despite these limitations, this study is the first prospective, intraindividual comparative study of its kind. It is therefore of significant interest, given its ability to control for individual-specific variables in the risk of ME and variations in medication compliance. The second study, by Wielders et al., reported the results of the ESCRS PREMED study, which is the largest multicenter randomized superior to both bromfenac alone and dexamethasone alone in the prevention of CME at 6 weeks. However, this was not clinically significant at 12 weeks based on improvements in visual acuity. Additionally, patients treated with dexamethasone alone demonstrated thicker CST at 6 weeks compared to both bromfenac alone and combina- tion therapy, which normalized by 12 weeks. Most importantly, there was no difference in best corrected distance visual acuity at 6 and 12 weeks postoperatively among the three groups. Though not statisti- cally significant, the trend toward Topical continued from page 63 A randomized controlled European multicentre trial on the prevention of cystoid macular edema after cataract surgery in non-diabetics: ESCRS PREMED study report 1 Laura Wielders, MD, Jan Schouten, MD, Bjorn Winkens, PhD, Frank van den Biggelaar, PhD, Claudette Veldhuizen, MD, Oliver Findl, MD, Joaquim Murta, MD, Willem Goslings, MD, Marie-José Tassignon, MD, Maurits Joosse, MD, Ype Henry, MD, Alexander Rulo, MD, José Güell, MD, Michael Amon, MD, Thomas Kohnen, MD, Rudy Nuijts, MD J Cataract Refract Surg. 2018;44(4). Article in press. Purpose: Cystoid macular edema (CME) is an important cause of suboptimal visual acuity after cataract surgery. The PREvention of Macular EDema after cataract surgery (PREMED) study compares the efficacy of a topical non-steroidal anti-inflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of CME after cataract surgery in non-diabetic patients. Setting: Twelve European study centres. Design: A multicentre randomized controlled clinical trial. Methods: Non-diabetic patients, undergoing uncomplicated cataract surgery, were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks, dexamethasone 0.1% four times daily and one drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness (CSMT) at 6 weeks postoperatively. Secondary outcome measures include corrected distance visual acuity, as well as the incidence of CME and clinically significant macular edema (CSME) within 6 and 12 weeks postoperatively. Results: A total of 914 patients were included in this study. At 6 weeks postoperatively, CSMT was 288.3 μm, 296.0 μm, and 284.5 μm in the bromfenac, dexamethasone, and combination treatment groups, respectively (overall p=0.006). The incidence of CSME within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5% in the bromfenac, dexamethasone, and combination treatment groups, respectively (overall p=0.043). Conclusions: Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% have a lower risk of developing CSME after cataract surgery, as compared to patients treated with a single drug. Intraindividual comparison of nepafenac 0.3% for the prevention of macular edema after phacoemulsification: Prospective randomized study Patrick Frensel Tzelikis, MD, Clézio Morato, MD, Nathália Teles Neves, MD, Wilson Takashi Hida, MD, Milton Ruiz Alves, MD J Cataract Refract Surg. 2018;44(4). Article in press. Purpose: To compare the anti-inflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular edema (ME) after cataract extraction. Setting: São Paulo University, São Paulo, SP, Brazil. Design: Randomized prospective intraindividual comparative study. Methods: Two hundred and twenty-four eyes of 112 patients with bilateral cataract were included in this study. Each patient was assigned randomly to receive nepafenac 0.3% drops in one eye and a placebo in the fellow eye. Primary outcome measure was the change in spectral domain optical coherence tomography mean central subfield thickness (CST) at 5 weeks postoperatively. The secondary outcome measures were the total macular volume (TMV) at 1, 5, and 12 weeks postoperatively, the percentage of patients in both groups who demonstrated macular edema, and the best corrected distance visual acuity within 5 and 12 weeks after cataract surgery. Results: In all retinal thickness measurements, a significant increase in both groups was detected starting from the first postoperative week until 12 weeks. At 5 weeks, there was a statistically significant difference in CST and TMV between the nepafenac and control group (P=0.01 and P<0.001, respectively). At the 5th postoperative week, none of the eyes in the nepafenac group and four (3.57%) eyes in the control group showed macula edema, highlighting a trend toward greater incidence in the control group. The between-group differences in visual outcomes were not statistically significant. Conclusion: Used prophylactically after cataract surgery, nepafenac 0.3% was efficacious in reducing macular thickness compared to placebo at 5 weeks postoperatively, without a difference in final visual acuity. controlled trial comparing the use of bromfenac 0.09% alone, dexameth- asone 0.1% alone, and the combi- nation of both in the prevention of cystoid macular edema (CME) post phacoemulsification. The goal of the study was to determine if there was a benefit of combination therapy in comparison to treatment with a single agent. With a total of 914 non-diabetic patients included in the study, it is the largest study to date comparing topical NSAIDs, corticosteroids, and combination therapy for the prevention of post- operative CME. The ESCRS study demonstrat- ed that combination therapy was

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