Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema

Peter A Campochiaro; Yong S Han; Tahreem A Mir; Saleema Kherani; Gulnar Hafiz; Claudia Krispel; T Y Alvin Liu; Jiangxia Wang; Adrienne W Scott; Ingrid Zimmer-Galler

doi:10.1016/j.ajo.2017.03.033

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Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema

Journal article

Peer reviewed

Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema

Peter A Campochiaro, Yong S Han, Tahreem A Mir, Saleema Kherani, Gulnar Hafiz, Claudia Krispel, T Y Alvin Liu, Jiangxia Wang, Adrienne W Scott and Ingrid Zimmer-Galler

American journal of ophthalmology, Vol.178, pp.163-175

06/01/2017

DOI: 10.1016/j.ajo.2017.03.033

PMID: 28392176

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Abstract

To compare standard and frequent topical steroids for postsurgical macular edema (ME). Randomized clinical trial. 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. 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). 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.

Administration, Topical

Aged

Anti-Inflammatory Agents, Non-Steroidal - administration & dosage

Cataract Extraction - adverse effects

Dose-Response Relationship, Drug

Drug Administration Schedule

Female

Follow-Up Studies

Glucocorticoids - administration & dosage

Humans

Ketorolac - administration & dosage

Macula Lutea - pathology

Macular Edema - diagnosis

Macular Edema - drug therapy

Macular Edema - etiology

Male

Middle Aged

Postoperative Complications

Prednisolone - administration & dosage

Prednisolone - analogs & derivatives

Prodrugs

Tomography, Optical Coherence

Treatment Outcome

Visual Acuity

Details

Title: Subtitle: Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema
Creators: Peter A Campochiaro - Johns Hopkins University
Yong S Han - Johns Hopkins University
Tahreem A Mir - Johns Hopkins University
Saleema Kherani - Johns Hopkins University
Gulnar Hafiz - Johns Hopkins University
Claudia Krispel - Johns Hopkins University
T Y Alvin Liu - Johns Hopkins University
Jiangxia Wang - Johns Hopkins University
Adrienne W Scott - Johns Hopkins University
Ingrid Zimmer-Galler - Johns Hopkins University
Resource Type: Journal article
Publication Details: American journal of ophthalmology, Vol.178, pp.163-175
DOI: 10.1016/j.ajo.2017.03.033
PMID: 28392176
ISSN: 0002-9394
eISSN: 1879-1891
Language: English
Date published: 06/01/2017
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9984755391202771

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