title: Perioperative Topical Nonsteroidal Anti-inflammatory Drugs for Macular Edema Prophylaxis Following Cataract Surgery.
abstract: OBJECTIVE
  To describe the effect of routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of postoperative macular edema (PME) after cataract surgery. The role of diabetic retinopathy on the relationship between NSAID use and PME was further analyzed.
  
  
  METHODS
  Retrospective matched cohort study.
  
  
  METHODS
  Patients undergoing cataract surgery between January 2007 and June 2014 were included in this study. A total of 108 093 Kaiser Permanente Southern California patients underwent cataract surgery and 89 731 met inclusion criteria. Cataract surgery patients who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only. The main outcome measure was the diagnosis of macular edema within 90 days of cataract surgery.
  
  
  RESULTS
  A prescription for an NSAID was filled by 56.4% of patients. The prevalence of PME was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs. The number needed to treat was 320 patients to prevent 1 case of PME. A matched cohort analysis was performed to account for confounders. NSAID use was associated with a lower incidence of PME in patients without diabetes [relative risk (RR) 0.68, 95% confidence interval (CI) 0.58-0.72] and diabetics without retinopathy (RR 0.51, 95% CI 0.32-0.82). NSAID use was not associated with a change in the incidence of PME among patients with diabetic retinopathy (RR 1.06, 95% 0.81-1.38).
  
  
  CONCLUSIONS
  Topical NSAIDs were associated with a modest reduction of PME incidence in patients undergoing cataract surgery; however, this relationship was not seen among those with diabetic retinopathy. The risk for PME is low and the number of patients benefiting from treatment is small.
authors.affiliation: Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California. Electronic address: bobmodj@gmail.com.
authors.forename: Bobeck S
authors.initials: BS
authors.lastname: Modjtahedi
authors.affiliation: Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California.
authors.forename: John F
authors.initials: JF
authors.lastname: Paschal
authors.affiliation: Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Batech
authors.affiliation: Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California.
authors.forename: Tiffany Q
authors.initials: TQ
authors.lastname: Luong
authors.affiliation: Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Fong
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002140:California / Q000453:epidemiology; D002387:Cataract Extraction; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008269:Macular Edema / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions