title: Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery.
abstract: OBJECTIVE
  To study the relationship of chemoprophylaxis and other factors with the occurrence of acute, clinical, postoperative macular edema.
  
  
  METHODS
  Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with a nonsteroidal anti-inflammatory drug (NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone.
  
  
  METHODS
  Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, from 2007 through 2013.
  
  
  METHODS
  We identified incident macular edema diagnoses that had been recorded 5 to 120 days after phacoemulsification with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy status, other ocular comorbidities, systemic comorbidities, and posterior capsular rupture status.
  
  
  METHODS
  Incident rates of acute, clinical, postoperative macular edema.
  
  
  RESULTS
  We confirmed 118 cases among 16 070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21-0.95) and that for TA injection was 1.21 (95% CI, 0.48-3.06). The frequency of intraocular pressure spikes of 30 mmHg or more between postoperative days 16 and 45 was 0.6% in the topical PA group, 0.3% in the topical PA+NSAID group (P = 0.13), and 0.8% for the TA group (P = 0.52). Black race was associated with a risk of macular edema (OR, 2.86; 95% CI, 1.41-5.79).
  
  
  CONCLUSIONS
  Adding a prophylactic NSAID to PA treatment was associated with a reduced risk of macular edema with visual acuity of 20/40 or worse. The risk and safety of TA injection were similar to those of PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, the risk among black people, and the effectiveness of depot medications.
authors.affiliation: Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California. Electronic address: nshorstein@eyeonsight.org.
authors.forename: Neal H
authors.initials: NH
authors.lastname: Shorstein
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Ophthalmology, Kaiser Permanente, Fresno, California.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Waxman
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005480:Flurbiprofen / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D056965:Injections, Intraocular; D020910:Ketorolac / Q000008:administration & dosage; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D004008:Diclofenac; D005480:Flurbiprofen; C009935:prednisolone acetate; D011239:Prednisolone; D014222:Triamcinolone Acetonide; D020910:Ketorolac