Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery

 

Abstract

Background

Cystoid macular oedema (CMO) is the accumulation of fluid in the central retina (the macula) due to leakage from dilated capillaries. It is the most common cause of poor visual outcome following cataract surgery. The exact cause is unclear. Acute CMO, defined as oedema of less than four months duration, often resolve spontaneously. CMO that persists for four months or more is termed chronic CMO. Different types of non-steroidal anti-inflammatory agents (NSAIDs) are used in the treatment of CMO which may be delivered topically or systemically.

Objectives

To examine the effectiveness of NSAIDs in the treatment of CMO following cataract surgery.

Search methods

We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (1966 to September 2008), EMBASE (1980 to September 2008), LILACS (September 2008) and the reference lists of identified trials. We searched conference abstracts (sessions related to cataract) in ARVO 1975 to 2003. We contacted experts in the field and NSAIDs manufacturers for details on published and unpublished trials.

Selection criteria

We included randomised controlled trials evaluating the effects of NSAIDs in the treatment of CMO following cataract surgery.

Data collection and analysis

Two review authors independently extracted data. Since considerable heterogeneity was observed between studies we did not conduct meta-analyses.

Main results

Seven trials involving a total of 266 participants were included. Four trials studied the effects of NSAIDs in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. Of the studies examining chronic CMO, one study enrolled 120 participants, but the remainder had 34 or fewer participants. Four different NSAIDs were used and administered in different ways. Indomethacin was used orally and was found to be ineffective for chronic CMO in one trial. Topical fenoprofen was also found to be ineffective for chronic CMO in another small trial. Treatment with topical 0.5% ketorolac for chronic CMO was found to be effective in two trials. Three trials examined the effect of topical NSAIDs on acute CMO. The comparisons among these studies were of an NSAID to placebo, prednisolone or another NSAID. The study design differed between the studies in other important aspects thus they could not be combined in a meta-analysis.

Authors' conclusions

This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO. However, the effects of NSAIDs in acute CMO remains unclear and needs further investigation.

 

Plain language summary

Non-steroidal anti-inflammatory drugs for treating cystoid macular oedema after cataract surgery

Cystoid macular oedema (CMO) is the accumulation of fluid in the macula (central retina) due to leakage from capillaries. Clinically significant CMO following cataract surgery is a complication of unknown cause. Acute CMO, defined as oedema of less than four months duration, often gets better spontaneously. This review included seven randomised controlled trial with a total of 266 participants. Four trials studied the effects of NSAIDs in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO. However, the effects of NSAIDs in acute CMO remains unclear and needs further investigation.

 

摘要

背景

非類固醇抗發炎劑用於治療白內障手術後的黃斑囊樣水腫

黃斑囊樣水腫(Cystoid macular oedema (CMO))是因為微血管的液體溢流而累積在中央視網膜(黃斑部)。它是造成白內障術後視力不佳最常見的原因。確切的原因尚不清楚。急性CMO(定義為四個月內的水腫)通常會自動痊癒。CMO持續四個月或以上被稱為慢性CMO。不同類型的非類固醇抗發炎劑(nonsteroidal antiinflammatory agents (NSAIDs))被用於治療CMO，可能會以局部或全身性的方式給予。

目標

評估NSAIDs治療白內障術後CMO的效果。

搜尋策略

檢索考科藍圖書館的CENTRAL (2006年，第3期)，MEDLINE (1966至2006年9月)，EMBASE (1980至2006年9月)，LILACS (2006年9月)及已確定文章的參考文獻。1975至2003年ARVO的會議摘要(與白內障有關的會議)。聯絡該領域的專家與NSAIDs廠商以了解已發表與未發表試驗的細節。

選擇標準

我們納入評估NSAIDs治療白內障術後CMO效果之隨機對照試驗。

資料收集與分析

兩名審查的作者分別獨立地摘錄資料。由於發現研究間具有相當的異質性，因此我們沒有進行統合分析。

主要結論

納入七篇試驗，共包含266名研究對象。四篇研究有關NSAIDs對於慢性CMO的效果，而其他三篇評估NSAIDs對於急性CMO的效果。在評估慢性CMO的研究中，一篇研究納入120名研究對象，但其餘的研究有34名或更少的研究對象。使用四種不同的NSAIDs及不同的給予方式。Indomethacin是口服的藥物且一篇研究發現其對於慢性CMO不具有效果。另一篇小型試驗也發現局部的fenoprofen對於慢性CMO不具有效果。兩篇試驗發現局部的0.5% ketorolac治療慢性CMO是有效的。三篇試驗評估局部的NSAIDs對於急性CMO的效果。這些研究是比較一種NSAID對照於安慰劑，prednisolone或其他的NSAID。研究之間其他重要面向的研究設計不同 ，因此無法將它們合併於統合分析中。

作者結論

這篇回顧發現兩篇試驗，其顯示局部的NSAID(0.5% ketorolac tromethamine點眼液)對於慢性CMO有正向的效果。然而，NSAIDs對於急性CMO的效果尚不清楚且需要進一步研究。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

非類固醇抗發炎劑用於治療白內障術後的黃斑囊樣水腫。黃斑囊樣水腫(CMO)是因為微血管的液體溢流而累積在黃斑部(中央視網膜)。臨床上重要的CMO是一種白內障術後不明原因的併發症。急性CMO(定義為四個月內的水腫)通常會自動痊癒。這篇回顧納入七篇隨機對照試驗，共包含266名研究對象。四篇試驗研究NSAIDs 對於慢性CMO的效果，而其他三篇則研究NSAIDs對於急性CMO的效果。這篇回顧發現兩篇試驗，其顯示局部的NSAID (0.5% ketorolac tromethamine點眼液)對於慢性CMO有正向效果。然而，NSAIDs對於急性CMO的效果尚不清楚且需要進一步研究。