title: Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema.
abstract: OBJECTIVE
  To compare standard and frequent topical steroids for postsurgical macular edema (ME).
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Subjects with postsurgical ME stratified into post-cataract surgery ME (PCSME) and post-other surgery ME (POSME) were randomized to ketorolac 4 times a day (qid) + 1% prednisolone acetate (PA) every hour while awake (q1hWA, Group 1) or qid (Group 2). Mean change from baseline best-corrected visual acuity (BCVA) was determined at week 12, after which group 2 subjects with persistent edema were crossed over to PA q1hWA.
  
  
  RESULTS
  Twenty-two subjects (13 PCSME and 9 POSME) were randomized to Group 1 and 20 (12 PCSME and 8 POSME) to Group 2. At week 12, change from baseline BCVA (ETDRS letters) in Group 1 vs 2 was +11.6 vs +8.5 (P = .32) and for subgroups was +10.6 vs +7.8 (P = .23) for PCSME and +13.1 vs +9.4 (P = .47) for POSME. Mean change from baseline central subfield thickness (CST, μm) at week 12 in Group 1 vs 2 was -100.8 vs -63.9 (P = .30). Mean change from baseline intraocular pressure was +2.6 vs +1.7 mm Hg (P = .52). Eight subjects in Group 2 with residual ME at week 12 were switched to PA q1hWA and at week 24, the mean changes from week 12 BCVA and CST were +7.0 letters (P = .01) and -108.25 μm (P = .04).
  
  
  CONCLUSIONS
  Our data suggest that patients with postsurgical ME should initially be treated with ketorolac and PA qid, but if edema does not resolve after 12 weeks, a switch to ketorolac qid and PA q1hWA may provide benefit.
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. Electronic address: pcampo@jhmi.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Campochiaro
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Yong S
authors.initials: YS
authors.lastname: Han
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Tahreem A
authors.initials: TA
authors.lastname: Mir
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Saleema
authors.initials: S
authors.lastname: Kherani
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Gulnar
authors.initials: G
authors.lastname: Hafiz
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Krispel
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: T Y Alvin
authors.initials: TYA
authors.lastname: Liu
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Wang
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Adrienne W
authors.initials: AW
authors.lastname: Scott
authors.affiliation: The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Zimmer-Galler
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D002387:Cataract Extraction / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011355:Prodrugs; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D011355:Prodrugs; C009935:prednisolone acetate; D011239:Prednisolone; D020910:Ketorolac