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, Tin Yan Liu, Jiangxia Wang, Adrienne Scott, Ingrid E Zimmer Galler

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)163-175
Number of pages13
JournalAmerican Journal of Ophthalmology
Volume178
DOIs
StatePublished - Jun 1 2017

Fingerprint

Macular Edema
Steroids
Ketorolac
Visual Acuity
Edema
Pyridinolcarbamate
Intraocular Pressure
Randomized Controlled Trials
prednisolone acetate

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{09dbf5bce6344af1b282abda2d25fc49,
title = "Increased Frequency of Topical Steroids Provides Benefit in Patients With Recalcitrant Postsurgical Macular Edema",
abstract = "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.",
author = "Campochiaro, {Peter A} and Han, {Yong S.} and Mir, {Tahreem A.} and Saleema Kherani and Gulnar Hafiz and Claudia Krispel and Liu, {Tin Yan} and Jiangxia Wang and Adrienne Scott and {Zimmer Galler}, {Ingrid E}",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.ajo.2017.03.033",
language = "English (US)",
volume = "178",
pages = "163--175",
journal = "American Journal of Ophthalmology",
issn = "0002-9394",
publisher = "Elsevier USA",

}

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, Tin Yan

AU - Wang, Jiangxia

AU - Scott, Adrienne

AU - Zimmer Galler, Ingrid E

PY - 2017/6/1

Y1 - 2017/6/1

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.

UR - http://www.scopus.com/inward/record.url?scp=85018922483&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018922483&partnerID=8YFLogxK

U2 - 10.1016/j.ajo.2017.03.033

DO - 10.1016/j.ajo.2017.03.033

M3 - Article

C2 - 28392176

AN - SCOPUS:85018922483

VL - 178

SP - 163

EP - 175

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

SN - 0002-9394

ER -