Prevention of Cystoid Macular Edema after Cataract Surgery in Nondiabetic and Diabetic Patients: A Systematic Review and Meta-Analysis

Purpose To evaluate the optimum medical strategy to prevent cystoid macular edema (CME) after cataract surgery. Design Systematic review and meta-analysis. Methods setting: Cochrane, MEDLINE, and EMBASE databases were searched to identify eligible randomized controlled trials (RCTs). study population: RCTs comparing medical strategies to prevent CME after uncomplicated cataract surgery in nondiabetic and diabetic patients. observation procedures: Data were extracted by 2 authors independently. Quality of individual RCTs was assessed using the Cochrane Collaboration's tool for assessing risk of bias and Delphi criteria. main outcome measures: Odds of developing CME within 3 months postoperatively and foveal thickness, macular volume and corrected distance visual acuity change within 3 months postoperatively, as compared to baseline. Results Seventeen trials reported incidence rates. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (odds ratio [OR] 0.11; 95% confidence interval [95% CI] 0.03–0.37) and mixed populations (OR 0.05; 95% CI 0.02–0.11). A combination of topical corticosteroids and NSAIDs significantly reduced the odds of developing CME as compared to topical corticosteroids in nondiabetic (OR 0.21; 95% CI 0.10–0.44) and diabetic patients (OR 0.17; 95% CI 0.05–0.50). Intravitreal corticosteroid or anti–vascular endothelial growth factor injections did not show any additional benefit in diabetic subjects. Conclusions Topical NSAIDs significantly reduced the odds of developing CME, as compared to topical corticosteroids, in nondiabetic and mixed populations. A combination of topical NSAIDs and corticosteroids reduced the odds of developing CME in nondiabetic and diabetic patients, as compared to topical corticosteroids.