RESUMEN
PURPOSE: To compare the efficacy of perioperative treatment strategies, in addition to topical bromfenac 0.09% and dexamethasone 0.1%, to reduce the risk for developing cystoid macular edema (CME) after uneventful cataract surgery in diabetic patients. SETTING: Twelve European study centers. DESIGN: Randomized clinical trial. METHODS: Diabetic patients having phacoemulsification cataract surgery were randomly allocated to receive no additional treatment, a subconjunctival injection with 40 mg triamcinolone acetonide, an intravitreal injection with 1.25 mg bevacizumab, or a combination of both. The main outcomes were the difference in central subfield mean macular thickness, corrected distance visual acuity, and the incidence of CME and clinically significant macular edema within 6 and 12 weeks postoperatively. RESULTS: The study comprised 213 patients. At 6 and 12 weeks postoperatively, the central subfield mean macular thickness was 12.3 µm and 9.7 µm lower, respectively, in patients who received subconjunctival triamcinolone acetonide than patients who did not (P = .007 and P = .014, respectively). No patient who received subconjunctival triamcinolone acetonide developed CME. Intravitreal bevacizumab had no significant effect on macular thickness. CONCLUSIONS: Diabetic patients who received a subconjunctival injection with triamcinolone acetonide at the end of cataract surgery had a lower macular thickness and macular volume at 6 and 12 weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Retinopatía Diabética/complicaciones , Glucocorticoides/uso terapéutico , Implantación de Lentes Intraoculares , Edema Macular/prevención & control , Facoemulsificación , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Benzofenonas/administración & dosificación , Bevacizumab/uso terapéutico , Bromobencenos/administración & dosificación , Dexametasona/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intraoculares , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica , Triamcinolona Acetonida/uso terapéutico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Agudeza VisualRESUMEN
PURPOSE: To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. SETTING: Twelve European study centers. DESIGN: Randomized clinical trial. METHODS: Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6 weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6 weeks and 12 weeks postoperatively. RESULTS: This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3 µm, 296.0 µm, and 284.5 µm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P = .006). The incidence of clinically significant macular edema within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P = .043). CONCLUSION: Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug.
Asunto(s)
Benzofenonas/administración & dosificación , Bromobencenos/administración & dosificación , Extracción de Catarata/efectos adversos , Dexametasona/administración & dosificación , Edema Macular/prevención & control , Agudeza Visual , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Diabetes Mellitus , Femenino , Glucocorticoides/administración & dosificación , Humanos , Edema Macular/diagnóstico , Edema Macular/etiología , Masculino , Soluciones Oftálmicas/administración & dosificación , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
PURPOSE: To assess adding straylight measurements to the indication for cataract surgery. SETTING: Onze Lieve Vrouwe Hospital, Amsterdam, and Zonnestraal Eye Clinic, Hilversum, The Netherlands. DESIGN: Prospective interventional cohort study. METHODS: Before and after cataract extraction, corrected distance visual acuity (CDVA) and straylight were recorded in all patients. Subjective complaints were documented by the 39-item National Eye Institute Visual Function Questionnaire (NEI VFQ-39) and a straylight questionnaire. RESULTS: The population comprised 217 patients with a mean age of 72 years ± 9.12 (SD) (range 29 to 90 years). Preoperatively, the mean straylight was 1.55 ± 0.29 log(s) and the mean CDVA, 0.28 ± 0.21 logMAR. Visual acuity and straylight showed little correlation (R(2) = 0.08). The mean postoperative improvement in CDVA was 0.26 ± 0.20 logMAR (range -0.12 to 1.12 logMAR) and in straylight, 0.31 ± 0.32 log(s) (range -0.50 to 1.27 log[s]). The preoperative breakeven point (50% chance of postoperative improvement) was 0.06 logMAR for CDVA and 1.29 log(s) for straylight. Preoperative and postoperative questionnaires showed straylight had almost the same influence as visual acuity on quality of vision. CONCLUSIONS: Straylight and visual acuity measure different aspects of quality of vision and influenced subjective visual quality almost equally. When straylight was added to preoperative considerations of cataract extraction, postoperative results were more predictable. FINANCIAL DISCLOSURE: The Netherlands Academy of Arts and Sciences has a proprietary interest in the C-Quant Straylight meter. No author has a financial or proprietary interest in any material or method mentioned.