Perioperative Topical Nonsteroidal Anti-inflammatory Drugs for Macular Edema Prophylaxis Following Cataract Surgery

PURPOSE: To describe the effect of routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of postoperative macular edema (PME) after cataract surgery. The role of diabetic retinopathy on the relationship between NSAID use and PME was further analyzed. DESIGN: Retrospective matched cohort study. METHODS: Patients undergoing cataract surgery between January 2007 and June 2014 were included in this study. A total of 108 093 Kaiser Permanente Southern California patients underwent cataract surgery and 89 731 met inclusion criteria. Cataract surgery patients who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only. The main outcome measure was the diagnosis of macular edema within 90 days of cataract surgery. RESULTS: A prescription for an NSAID was filled by 56.4% of patients. The prevalence of PME was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs. The number needed to treat was 320 patients to prevent 1 case of PME. A matched cohort analysis was performed to account for confounders. NSAID use was associated with a lower incidence of PME in patients without diabetes [relative risk (RR) 0.68, 95% confidence interval (CI) 0.58-0.72] and diabetics without retinopathy (RR 0.51, 95% CI 0.32-0.82). NSAID use was not associated with a change in the incidence of PME among patients with diabetic retinopathy (RR 1.06, 95% 0.81-1.38). CONCLUSION: Topical NSAIDs were associated with a modest reduction of PME incidence in patients undergoing cataract surgery; however, this relationship was not seen among those with diabetic retinopathy. The risk for PME is low and the number of patients benefiting from treatment is small. (C) 2017 Elsevier Inc. All rights reserved.)