Cataract removal is one of the most commonly performed surgeries and in recent years has benefited from advances in technique, lens design and instrumentation.1 Phacoemulsification surgery via small incisions and implantation of a foldable intraocular lens (IOL) is an effective procedure, and provides good visual outcomes.2–5
Post-operative complications of cataract surgery however, may occur, including cystoid macular edema (CME) which is the most common cause of visual loss following cataract surgery.6–8 It is more common in patients with ocular diseases such as uveitis or diabetic retinopathy and after complicated or uncomplicated surgery in patients with otherwise healthy eyes.9 The development of small incision cataract surgery and phacoemulsification techniques has lowered the incidence of CME, but the total volume of cataract surgeries makes it a common morbidity. Up to 80 % of symptomatic patients show spontaneous improvement in visual function three to 12 months post surgery. In a minority of patients, CME requires treatment and in some cases, it may be refractory to treatment.10
Prevention of CME through post-operative use of NSAIDs is now standard of care in the US and increasingly practiced in several other countries around the world. In addition, there have been several clinical studies that support the role of NSAIDs in helping prevent CME.8,10–15
This review considers the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of CME with a focus on bromfenac. Four case reports of rapid CME resolution after topical administration of bromfenac are discussed.
Definition, Incidence and Cost
CME can be detected using either clinical or angiographic methods. Clinical CME is diagnosed using slit-lamp biomicroscopic observation of cystoid abnormalities or angiographic evidence of perifoveal leakage as well as reduced visual acuity (VA). The angiographic CME is diagnosed using fluorescein angiography. The incidence of clinical CME is low, ranging from 0 to 4 %.16 The incidence of angiographic CME is higher; incidence rates of 19,15 2217 and 9 %18 have been reported.
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