What is The Comparative Effectiveness of Different Pharmacological Interventions in Preventing Cystoid Macular Edema after Cataract Surgery in Nondiabetic versus Diabetic Patients? : A Systematic Review
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Abstract
Cystoid macular edema (CME) is a common vision-impairing complication following cataract surgery, with diabetic patients exhibiting a higher predisposition due to pre-existing retinal microvascular changes. This systematic review evaluates the comparative effectiveness of pharmacological interventions—nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF) agents—in preventing CME in nondiabetic versus diabetic patients.
Methods: Adhering to PRISMA 2020 guidelines, this systematic review included randomized controlled trials, systematic reviews, and meta-analyses that assessed pharmacological CME prevention in adult cataract surgery patients, differentiated by diabetic status. Searched databases included PubMed, Semantic Scholar, Sagepub, and Google Scholar. Primary outcomes analyzed were CME incidence, central retinal thickness (CRT) measured by optical coherence tomography (OCT), and best-corrected visual acuity (BCVA).
Results: In nondiabetic patients, NSAIDs, alone or combined with corticosteroids, demonstrated superior efficacy in reducing CME incidence (e.g., 1.5% with bromfenac/dexamethasone combination vs. 5.1% with dexamethasone alone) and stabilizing CRT compared to corticosteroid monotherapy or placebo. For diabetic patients, NSAIDs, corticosteroids, and anti-VEGF agents all contributed to lower CME incidence (e.g., ranibizumab reducing rates from 17.1% to 2.7%) and reduced CRT. Visual acuity outcomes generally improved with active interventions in both groups, though some studies reported no significant differences. Interventions were generally well-tolerated; corticosteroids posed a risk of increased intraocular pressure, particularly in diabetics.
Discussion: The evidence supports NSAIDs as a cornerstone for CME prophylaxis in nondiabetic patients by mitigating postoperative inflammation. Diabetic patients, with their compromised retinal vasculature, benefit from a broader pharmacological spectrum, including anti-VEGF agents that target VEGF-mediated permeability. Combination therapies often yield the most significant protective effects.
Conclusion: Pharmacological interventions are effective in preventing post-cataract surgery CME. NSAIDs, alone or with corticosteroids, are recommended for nondiabetic patients. A multimodal approach, potentially incorporating NSAIDs, corticosteroids, and anti-VEGF agents, is advisable for diabetic patients, tailored to individual risk profiles.
Methods: Adhering to PRISMA 2020 guidelines, this systematic review included randomized controlled trials, systematic reviews, and meta-analyses that assessed pharmacological CME prevention in adult cataract surgery patients, differentiated by diabetic status. Searched databases included PubMed, Semantic Scholar, Sagepub, and Google Scholar. Primary outcomes analyzed were CME incidence, central retinal thickness (CRT) measured by optical coherence tomography (OCT), and best-corrected visual acuity (BCVA).
Results: In nondiabetic patients, NSAIDs, alone or combined with corticosteroids, demonstrated superior efficacy in reducing CME incidence (e.g., 1.5% with bromfenac/dexamethasone combination vs. 5.1% with dexamethasone alone) and stabilizing CRT compared to corticosteroid monotherapy or placebo. For diabetic patients, NSAIDs, corticosteroids, and anti-VEGF agents all contributed to lower CME incidence (e.g., ranibizumab reducing rates from 17.1% to 2.7%) and reduced CRT. Visual acuity outcomes generally improved with active interventions in both groups, though some studies reported no significant differences. Interventions were generally well-tolerated; corticosteroids posed a risk of increased intraocular pressure, particularly in diabetics.
Discussion: The evidence supports NSAIDs as a cornerstone for CME prophylaxis in nondiabetic patients by mitigating postoperative inflammation. Diabetic patients, with their compromised retinal vasculature, benefit from a broader pharmacological spectrum, including anti-VEGF agents that target VEGF-mediated permeability. Combination therapies often yield the most significant protective effects.
Conclusion: Pharmacological interventions are effective in preventing post-cataract surgery CME. NSAIDs, alone or with corticosteroids, are recommended for nondiabetic patients. A multimodal approach, potentially incorporating NSAIDs, corticosteroids, and anti-VEGF agents, is advisable for diabetic patients, tailored to individual risk profiles.
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