January 2008




Prophylaxis NSAID use could complicate wound healing in ECCE


With an increase in the use of nonsteroidal anti-inflammatory agents for prophylaxis of cystoid macular edema (CME) after cataract surgery, Mark L. Arey, M.D., suggested caution in liberal usage after extracapsular cataract extraction (ECCE).

The results from this study were published in the December issue of Cornea and also were presented by Dr. Arey, University of Texas Southwestern Medical Center, Dallas, as a poster at the 2006 ASCRS Congress & Symposium in San Francisco.

For the retrospective case series study, Dr. Arey and his colleagues reviewed 31 patients who underwent uncomplicated ECCE with intraocular lens (IOL) implantation (20) or uncomplicated phacoemulsification with IOL implantation (11). All were treated postoperatively with Acular LS (ketorolac 0.5%, Allergan, Irvine, Calif.) four times daily for an average of 30 days (range, 20-44 days) as a prophylactic measure against CME. Of this group, seven eyes of seven patients developed impaired wound healing. All seven eyes had ECCE.

The researchers reported that of the patients treated with Acular LS, two eyes developed post-op endophthalmitis necessitating vitreous tap with intravitreal antibiotic injection. Also one eye went on to require pars plana vitrectomy with corneal wound re-suturing.

Other complications included one eye that developed corneal wound dehiscence that required wound re-suturing in the operating room. Another eye developed an inadvertent filtering bleb despite the lack of post-op suture lysis.

The remaining three eyes were followed up closely in the post-op period with slit-lamp evidence of impaired wound healing, manifested by wound avascularity and/or wound gape, but did not require surgical intervention, Dr. Arey reported.

Seven of twenty eyes (35%) which were treated with Acular LS for an average of 26 days following uncomplicated ECCE with IOL implantations had impaired wound healing during the post-operative period, Dr. Arey and his colleagues concluded. This case series suggests an association between the use of ketorolac 0.5% and impaired corneal wound healing.

Proponents of NSAIDs as prophylaxis usually cite numerous studies documenting the reduced incidence of post-op CME in patients after cataract surgery; however, Dr. Arey said the majority of previously reported series involve small-incision phaco rather than ECCE, which requires a much larger incision and comparatively longer healing.

The larger corneoscleral incision performed in our cases of manual ECCE may have resulted in the normal inflammatory activation, which may have been potentiated by the use of a topical NSAID, he said.

Therefore, Dr. Arey recommended that a prospective study to further assess the safety and efficacy of NSAIDs in post-op ECCE is needed to warrant their routine use.

Editors’ note: Dr. Arey did not have any financial interests related to this study. The study was supported by Research to Prevent Blindness.

Source: EyeWorld News Services

Prophylaxis NSAID use could complicate wound healing in ECCE Prophylaxis NSAID use could complicate wound healing in ECCE
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