TY - JOUR
T1 - Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema
AU - Campochiaro, Peter A.
AU - Han, Yong S.
AU - Mir, Tahreem A.
AU - Kherani, Saleema
AU - Hafiz, Gulnar
AU - Krispel, Claudia
AU - Liu, T. Y.Alvin
AU - Wang, Jiangxia
AU - Scott, Adrienne W.
AU - Zimmer-Galler, Ingrid
PY - 2017/6
Y1 - 2017/6
N2 - Purpose To compare standard and frequent topical steroids for postsurgical macular edema (ME). Design 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.
AB - Purpose To compare standard and frequent topical steroids for postsurgical macular edema (ME). Design 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.
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U2 - 10.1016/j.ajo.2017.03.033
DO - 10.1016/j.ajo.2017.03.033
M3 - Article
C2 - 28392176
AN - SCOPUS:85018922483
SN - 0002-9394
VL - 178
SP - 163
EP - 175
JO - American journal of ophthalmology
JF - American journal of ophthalmology
ER -