Risk Factors and Incidence of Macular Edema after Cataract Surgery: A Database Study of 81984 Eyes

Cataract Surgery in Patients with Diabetes: Management Strategies

Diabetes is a chronic systemic disease that affects nearly one in eight adults worldwide. Ocular complications, such as cataract, can lead to significant visual impairment. Among the worldwide population, cataract is the leading cause of blindness, and patients with diabetes have an increased incidence of cataracts which mature earlier compared to the rest of the population. Cataract surgery is a common and safe procedure, but can be associated with vision-threatening complications in the diabetic population, such as diabetic macular edema, postoperative macular edema, diabetic retinopathy progression, and posterior capsular opacification. This article is a brief review of diabetic cataract and complications associated with cataract extraction in this population of patients.

Irvine-Gass Macular Edema Responding to the Combination of Oral Mineralocorticoid-Receptor Antagonist With Dexamethasone Drops

Long-lasting postoperative macular edema is a therapeutic challenge. The authors report an efficient combination therapy of oral mineralocorticoid receptor antagonists (eplerenone [Inspra; Pfizer, New York City, NY] or spironolactone, 25 mg/day to 50 mg/day) and topical dexamethasone (four times/day and progressive dose tapering) in three refractory cases following complex cataract or retinal detachment surgery. In Case 1, central macular thickness (CMT) decreased from 523 μm to 214 μm and visual acuity (VA) improved from 20/200 to 20/50 during a 6-month period. In Cases 2 and 3, CMT improved from 505 μm to 333 μm and from 438 μm to 316 μm during 5- and 3-month periods, respectively; however, VA remained unchanged (20/100 and 20/200) due to photoreceptor damage. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:936-942.].

The Effect of Latanaprost on Intraocular Inflammation and Macular Edema

There is debate concerning whether the use of Latanoprost in early postoperative period of cataract surgery and in glaucoma patients with uveitis as it may aggravate the inflammation and results in macular edema (ME), because of blood-ocular barrier disruption. However, there is no solid evidence for disruption of blood-ocular barrier with Latanoprost and aggravation of uveitis or ME formation. Similar to pseudophakic ME, the imaging ME in cases claimed to be secondary to Latanoprost is greater than clinical ME, happens mostly in complicated surgeries, and the vast majority resolve within weeks to months with using a non-steroidal anti-inflammatory drug. The current literature suggests that Latanoprost can be used in patients with uveitis and early after cataract surgery with or without concomitant topical non-steroidal anti-inflammatory drugs that are currently used by many ophthalmologists as a preventive measure for ME even in non-glaucoma uncomplicated cataract surgeries.

Choroidal thickness changes following cataract surgery using swept source optical coherence tomography

OBJECTIVE

The aim of this study was to assess changes in subfoveal choroidal thickness (SFCT), measured using swept-source optical coherence tomography (SS-OCT), after routine phacoemulsification cataract surgery.

DESIGN

This is a prospective, interventional, controlled study that took place at Shahzad Eye Hospital, Karachi, Pakistan, between February 2015 and January 2016.

PARTICIPANTS

One hundred and one patients who were undergoing routine cataract surgery were recruited. One eye per patient was included. The unoperated fellow eyes acted as controls.

METHODS

Swept-source optical coherence tomography scans were performed preoperatively, 1 week postoperatively, and 1 month postoperatively. Two independent graders evaluated the scans to measure the SFCT. The SFCT was measured and recorded for OCT scans from each visit. The general linear model repeated analysis technique was used to assess data from the 3 different time intervals, and paired t tests were used to assess a statistically significant difference between mean preoperative and postoperative SFCT. Probability values of less than 0.05 were considered to be statistically significant.

RESULTS

The mean preoperative SFCT in the study eye was 272.9 ± 96.2; SFCT was 278.9 ± 101.4 (p = 0.051) and 281.5 ± 105.2 (p = 0.01) at week 1 and month 1, respectively. In the control eyes, the mean measurement of preoperative SFCT was 274.2 ± 98.5; measurements were 273.8 ± 100.7 (p = 0.875) and 277.9 ± 103.1 (p = 0.063) at week 1 and month 1, respectively.

CONCLUSIONS

There was a gradual increase in SFCT at 1 month after cataract removal in the study eyes. The effect was more pronounced in younger individuals and nondiabetic individuals.

Cataracts

An estimated 95 million people worldwide are affected by cataract. Cataract still remains the leading cause of blindness in middle-income and low-income countries. With the advancement of surgical technology and techniques, cataract surgery has evolved to small-incisional surgery with rapid visual recovery, good visual outcomes, and minimal complications in most patients. With the development of advanced technology in intraocular lenses, the combined treatment of cataract and astigmatism or presbyopia, or both, is possible. Paediatric cataracts have a different pathogenesis, surgical concerns, and postoperative clinical course from those of age-related cataracts, and the visual outcome is multifactorial and dependent on postoperative visual rehabilitation. New developments in cataract surgery will continue to improve the visual, anatomical, and patient-reported outcomes. Future work should focus on promoting the accessibility and quality of cataract surgery in developing countries.

Incidence of cystoid macular edema after Descemet's stripping automated endothelial keratoplasty

AIM

To determine the incidence of cystoid macular edema (CME) after Descemet's stripping automated endothelial keratoplasty (DSAEK).

METHODS

This study included all consecutive patients operated in a Spanish tertiary reference hospital over a period of four years. A total of 55 eyes from 47 patients matched the selection criteria. CME was diagnosed clinically at the slit-lamp and confirmed by optical coherence tomography.

RESULTS

Six cases of CME were diagnosed postoperatively, which represented an incidence of 11%. Three patients had previously undergone DSAEK alone (7%; 3/41) and the other three, DSAEK combined with phacoemulsification (21%; 3/14). Five out of six patients with CME responded to standard therapy.

CONCLUSION

CME is a possible complication after DSAEK and can be treated with standard therapy. CME appears more frequently when DSAEK is combined with phacoemulsification and posterior chamber (PC) intraocular lens (IOL) implantation. Intraoperative damage to the corneal endothelial cells might play a role in the pathogenesis of CME. As long as the causes remain unclear, we recommend administering prophylaxis when risk factors are present or when combined surgery is planned.

Pseudophakic Macular Edema in Primary Open-Angle Glaucoma: A Prospective Study Using Spectral-Domain Optical Coherence Tomography

PURPOSE

To determine the incidence of and risk factors for pseudophakic macular edema (PME) after uncomplicated cataract surgery in primary open-angle glaucoma (POAG) using spectral-domain optical coherence tomography (SDOCT).

DESIGN

Cohort study.

METHODS

Macular retinal thickness was evaluated using SDOCT at 1 week before surgery and at 1, 3, 6, and 12 months postoperatively, in 70 POAG and 68 control eyes. Forty-three healthy subjects without impaired vision or cystoid PME were recruited separately as pilot samples to define significant PME. Significant PME was defined as an increase in the average thickness exceeding the mean + 3 standard deviations of the increase shown in the pilot samples.

RESULTS

Significant PME (increase in the foveal 3-mm zone thickness of >19.5 μm) was observed in 31 (44%) eyes with POAG and in 14 (21%) control eyes (P = .003). The extent of PME was maximal at 3 months postoperatively and decreased gradually until 12 months. Regression tree analysis revealed that the risk of PME was the greatest in the POAG group using prostaglandin analogue (PGA) (odds ratio [OR] = 5.51), followed by POAG not using PGA (OR = 1.70), and control group (OR = 1.0). Risk factors for PME were younger age in all groups (OR = 1.07), systemic hypertension in PGA users (OR = 6.42), higher untreated IOP in PGA nonusers (OR = 1.09) and male sex (OR = 14.06) and diabetes mellitus (OR = 16.71) in the control group.

CONCLUSIONS

The incidence of PME as observed by SDOCT was higher than previously reported after uncomplicated cataract surgery. Eyes with POAG were at greater risk for PME, which was mainly associated with perioperative PGA use.

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

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.

Efficacy of nepafenac ophthalmic suspension 0.1% in improving clinical outcomes following cataract surgery in patients with diabetes: an analysis of two randomized studies

OBJECTIVE

To assess the efficacy of nepafenac 0.1% ophthalmic suspension in improving the clinical outcomes following cataract surgery (CS) in patients with nonproliferative diabetic retinopathy.

METHODS

In two similar multicenter, randomized studies, patients received either nepafenac 0.1% or vehicle, instilled three times daily starting a day prior to surgery and continuing for 90 days postoperatively. A post hoc analysis of these two studies was conducted to assess 1) the likelihood for development of postoperative macular edema (ME), based on the percentage of patients who developed ME (≥30% increase from preoperative baseline in central subfield macular thickness) within 90 days following CS and 2) best-corrected visual acuity (BCVA) endpoints, including the percentage of patients with a BCVA improvement of ≥15 letters from preoperative baseline to Day 14 and maintained through Day 90. Results for individual studies and their pooled estimates (only visual acuity endpoints) are reported. Primary inference was based on odds ratio (OR).

RESULTS

This post hoc analysis included 411 patients (nepafenac 0.1%: 205; vehicle: 206). The incidence of postoperative ME within 90 days of CS was notably lower in the nepafenac-treated patients than in vehicle-treated patients (study 1: 3.2% vs 16.7%; OR =0.2, 95% confidence interval [CI] =0.1, 0.5, P=0.001; study 2: 5.0% vs 17.5%; OR =0.2, 95% CI =0.1, 0.8, P=0.018). A higher percentage of nepafenac-treated patients than vehicle-treated patients gained ≥15 letters from preoperative baseline to Day 14, which was maintained through Day 90 (study 1: 38.4% vs 21.4%; OR =2.4, 95% CI =1.4, 4.2, P=0.003; study 2: 35.0% vs 25.0%; OR =1.6, 95% CI =0.8, 3.2, P=0.172; pooled: 37.1% vs 22.8%; OR =2.0, 95% CI =1.3, 3.1, P=0.001). The odds of >5-letter and >10-letter loss in BCVA from postoperative Day 7 were higher in vehicle-treated than in nepafenac-treated patients.

CONCLUSION

These results support the clinical benefit of prophylactic use of nepafenac 0.1% for reducing the risk of postoperative ME and for improvement in BCVA outcomes following CS in patients with nonproliferative diabetic retinopathy.

Diabetic macular oedema: clinical risk factors and emerging genetic influences

Diabetic macular oedema is the major cause of visual impairment in type 1 and type 2 diabetes. As type 2 diabetes becomes more prevalent worldwide, the prevalence of diabetic macular oedema is also expected to rise. Current management of diabetic macular oedema is challenging, expensive and not optimal in a subset of patients. Therefore, it is important to increase our understanding of the risk factors involved and develop preventative strategies. While clinical risk factors for diabetic macular oedema have been identified, few studies have addressed potential genetic risk factors. Epidemiology and family studies suggest genetic influences are of importance. In this review, we summarise known clinical risk factors, as well as discuss the small number of genetic studies that have been performed for diabetic macular oedema.

Perioperative Topical Nonsteroidal Anti-inflammatory Drugs for Macular Edema Prophylaxis Following Cataract Surgery

PURPOSE

To describe the effect of routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of postoperative macular edema (PME) after cataract surgery. The role of diabetic retinopathy on the relationship between NSAID use and PME was further analyzed.

DESIGN

Retrospective matched cohort study.

METHODS

Patients undergoing cataract surgery between January 2007 and June 2014 were included in this study. A total of 108 093 Kaiser Permanente Southern California patients underwent cataract surgery and 89 731 met inclusion criteria. Cataract surgery patients who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only. The main outcome measure was the diagnosis of macular edema within 90 days of cataract surgery.

RESULTS

A prescription for an NSAID was filled by 56.4% of patients. The prevalence of PME was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs. The number needed to treat was 320 patients to prevent 1 case of PME. A matched cohort analysis was performed to account for confounders. NSAID use was associated with a lower incidence of PME in patients without diabetes [relative risk (RR) 0.68, 95% confidence interval (CI) 0.58-0.72] and diabetics without retinopathy (RR 0.51, 95% CI 0.32-0.82). NSAID use was not associated with a change in the incidence of PME among patients with diabetic retinopathy (RR 1.06, 95% 0.81-1.38).

CONCLUSION

Topical NSAIDs were associated with a modest reduction of PME incidence in patients undergoing cataract surgery; however, this relationship was not seen among those with diabetic retinopathy. The risk for PME is low and the number of patients benefiting from treatment is small.

Visual complications in diabetes mellitus: beyond retinopathy

Diabetic retinopathy is the most common cause of vision loss in people with diabetes mellitus; however, other causes of visual impairment/loss include other retinal and non-retinal visual problems, including glaucoma, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataracts. Additionally, when a person with diabetes complains of visual disturbance despite a visual acuity of 6/6, abnormalities in refraction, contrast sensitivity, straylight and amplitude of accommodation should be considered. We review and highlight these visual problems for physicians who manage people with diabetes to ensure timely referral and treatment to limit visual disability, which can have a significant impact on daily living, especially for those participating in sports and driving.

Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo

Background

Define the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study.

Methods

Eyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use.

Results

PCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk.

Conclusion

Pseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors.

Trial registration

NIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945.

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy

Objective:

To determine the efficacy of topical Nepafenac (0.1%), administered post-operatively in prevention of Macular Edema (ME), after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy (NPDR).

Methods:

This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness (CMT) of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography.

Results:

Mean age of study population was 60.97±4.91 years. Out of 60 patients, 34 (56.7%) were males and 24 (43.3%) were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5±10.86µm, 228.83±14.56 µm, 2.33±10.45 µm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93±11.69µm, 236.17±16.16 µm, 12.23±12.40µm and 5.51% respectively. ME was observed in one patient (3.3%) in Group-1, and seven patients (23.3%) in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant (p<0.05).

Conclusion:

0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR).

Diabetic macular oedema

Diabetic macular oedema, characterised by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in people with diabetes. It affects one in 15 people with diabetes resulting in more than 20 million cases worldwide. Few epidemiological studies have been done to specifically investigate risk factors for diabetic macular oedema, although poor glycaemic and blood pressure control are associated with the presence and development of the disorder. The pathophysiological processes begin with chronic hyperglycaemia, and interplay between vascular endothelial growth factor (VEGF) and inflammatory mediators. Non-invasive imaging using optical coherence tomography has allowed clinicians to detect mild levels of diabetic macular oedema in order to monitor progress and guide treatment. Although focal or grid laser photocoagulation was the traditional mode of treatment, intraocular pharmacotherapy with anti-VEGF agents is now the standard of care. However, these therapies are expensive and resource intensive. Emerging therapeutic strategies include improving efficacy and duration of VEGF suppression, targeting alternative pathways such as inflammation, the kallikrein-kinin system, the angiopoietin-Tie2 system, and neurodegeneration, and using subthreshold and targeted laser therapy. Ongoing research should lead to improvements in screening, diagnosis, and management of diabetic macular oedema.

Modern Phacoemulsification and Intraocular Lens Implantation (Refractive Lens Exchange) Is Safe and Effective in Treating High Myopia

Improved efficacy, predictability, and safety of modern phacoemulsification have resulted in cataract surgery being considered as a refractive procedure. Refractive lens exchange by definition is a surgery aimed at replacing the cataractous or clear crystalline lens with an intraocular lens (IOL) in cases of high ametropia. The excellent intraocular optics of this procedure provide a better visual outcome as compared with laser refractive surgery in high myopia. With advances in technology and IOL formulas, the predictability of refractive outcome after cataract surgery in high myopes has improved. The option of addressing presbyopia using multifocal/accommodating IOLs or monovision results in patients achieving reasonable spectacle independence. The most important concern with respect to phacoemulsification in high myopia is the risk of pseudophakic retinal detachment. High myopia is an independent risk factor for retinal detachment, and recent publications have reported a much lesser risk of retinal detachment specifically attributable to phacoemulsification in high myopes, especially if a thorough posterior segment evaluation is done and patients are followed up until development of complete posterior vitreous detachment. Refractive lens exchange is an effective and safe option to correct high myopia and can significantly improve quality of life in select patients.

Management of macular oedema in diabetic patients undergoing cataract surgery

PURPOSE OF REVIEW

The aim of this study was to describe all the treatment modalities used to prevent and manage macular oedema in diabetic patients undergoing cataract surgery.

RECENT FINDINGS

Topical NSAIDs have been proposed to be an effective strategy to prevent postsurgical macular oedema (PME) in diabetic patients. The prophylactic use of intravitreal antivascular endothelial growth factors (anti-VEGF) drugs and steroids in these patients, even if effective, brings some concerns with regard to possible side effects. By contrast, in patients with a diagnosis of diabetic macular oedema (DME) at the time of cataract surgery, intravitreal therapy, both with anti-VEGF drugs and steroids, appears to be the best approach in order to control PME and achieve a good visual outcome.

CONCLUSION

All diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PME. Intravitreal anti-VEGF drugs and steroids, combined with cataract surgery, should be reserved for patients with preexisting DME.

Cataract surgery in uveitis: a multicentre database study

BACKGROUND/AIMS

Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared with non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts.

METHODS

Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared with a reference group of 95 573 eyes from the same dataset.

RESULTS

Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse preoperative visual acuity (0.87 vs 0.65 logarithm of the minimum angle of resolution (logMAR) units), were from younger patients and had shorter axial lengths and a higher incidence of ocular copathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer postoperative visual acuity at all time points measured up to 6 months (0.41 vs 0.27 logMAR units at 12-24 weeks).

CONCLUSIONS

This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, copathology and worse visual outcomes in this group. These data will allow more accurate preoperative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded, so that patient expectations are met. Compared with the non-uveitic population, the mean postoperative visual acuity is between one and two lines worse at all time points.

Visual Acuity, Retinal Sensitivity, and Macular Thickness Changes in Diabetic Patients without Diabetic Retinopathy after Cataract Surgery

Aim. Functional and morphological macular study after cataract surgery in a group of diabetics without diabetic retinopathy compared to nondiabetics to evaluate the effect of surgical oxidative stress on diabetic retina. Methods. Prospective, comparative study. Preoperative eye exam, best corrected visual acuity (BCVA) measured by ETDRS letters, and optical coherence tomography (OCT) were followed by standard cataract surgery. The follow-up visits at 1, 3, and 6 months postoperatively included BCVA, OCT, and microperimetry, to analyze changes within and between the groups. Results. The BCVA improved significantly in diabetics and controls: 64.2 to 81.0 and 61.9 to 82.1 ETDRS at 6 months, respectively. The central macula at OCT significantly thickened in both groups, while the central 5 fields, corresponding to the microperimetry area, subclinically thickened from 284.20 to 291.18 μm at 6 months only in diabetics (p = 0.026). A matching slight decrease in the microperimetry sensitivity from 1 to 6 months was found also only in diabetics, with mean average difference -0.75 dB (p = 0.04). Conclusion. Underlying diabetes does not influence the surgical outcome in diabetics without diabetic retinopathy. However, slight thickening of wider macula and corresponding decrease in retinal sensitivity observed in diabetics 6 months postoperatively might influence visual function on long term.

Down-Regulation of MicroRNA-133b Suppresses Apoptosis of Lens Epithelial Cell by Up-Regulating BCL2L2 in Age-Related Cataracts

Background

MicroRNA-133b (miR-133b) has been reported to be involved in many diseases, including ovarian cancer and osteosarcoma. Accumulating evidence suggests that miR-133b plays important roles in human disease. In this study, we aimed to investigate the molecular mechanism, including the potential regulator and signaling pathways, of BCL2L2.

Material/Methods

We first searched the online miRNA database (www.mirdb.org) using the “seed sequence” located within the 3′-UTR of the target gene, and then performed luciferase assay to test the regulatory relationship between miR-133b and BCL2L2. Western blot and real-time PCR were used to determine the expression of BCL2L2 in human samples or cells treated with miRNA mimics or inhibitors. Flow cytometry was conducted to evaluate the apoptosis status of the cells.

Results

We validated BCL2L2 to be the direct gene using a luciferase reporter assay. We also conducted real-time PCR and Western blot analyses to study the mRNA and protein expression level of BCL2L2 among different groups (control: n=29, cataract: n=33) or cells treated with scramble control, miR-133b mimics, BCL2L2 siRNA, and miR-133b inhibitors, and identified the negative regulatory relationship between miR-133b and BCL2L2. We also conducted experiments to investigate the influence of miR-133b and BCL2L2 on the viability and apoptosis of cells. The results showed that miR-133b positively interfered with the viability of cells, while BCL2L2 negatively interfered with the viability of cells, and that miR-133b inhibited apoptosis while BCL2L2 accelerated apoptosis.

Conclusions

BCL2L2 was the virtual target of miR-133b, and we found a negative regulatory relationship between miR-133b and BCL2L2. MiR-133b and BCL2L2 interfered with the viability and apoptosis of cells.

Laparoscopic Surgery Can Reduce Postoperative Edema Compared with Open Surgery

Aim. The study aimed to investigate the impact of laparoscopic surgery and open surgery on postoperative edema in Crohn's disease. Methods. Patients who required enterectomy were divided into open group (Group O) and laparoscopic group (Group L). Edema was measured using bioelectrical impedance analysis preoperatively (PRE) and on postoperative day 3 (POD3) and postoperative day 5 (POD5). The postoperative edema was divided into slight edema and edema by an edema index, defined as the ratio of total extracellular water to total body water. Results. Patients who underwent laparoscopic surgery had better clinical outcomes and lower levels of inflammatory and stress markers. A total of 31 patients (26.05%) developed slight edema and 53 patients (44.54%) developed edema on POD3. More patients developed postoperative edema in Group O than in Group L on POD3 (p = 0.006). The value of the edema index of Group O was higher than that of Group L on POD3 and POD5 (0.402 ± 0.010 versus 0.397 ± 0.008, p = 0.001; 0.401 ± 0.009 versus 0.395 ± 0.007, p = 0.039, resp.). Conclusions. Compared with open surgery, laparoscopic surgery can reduce postoperative edema, which may contribute to the better outcomes of laparoscopic surgery over open surgery.

Topical bromfenac for prevention and treatment of cystoid macular edema following cataract surgery: a review

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, alone or in combination, have historically been used off label in the US to prevent and treat postoperative cystoid macular edema (CME). This literature review presents available data on the use of bromfenac 0.07% or 0.09% to prevent and treat CME following cataract surgery. Bromfenac is an NSAID approved to treat postoperative inflammation and reduce ocular pain following cataract surgery. Few cases of clinical CME were observed with bromfenac use in a total of 19 reviewed studies. There were no significant differences in CME incidence between bromfenac and corticosteroid-treated patients or between bromfenac- and bromfenac plus corticosteroid-treated patients. Bromfenac demonstrated comparable efficacy to other NSAIDs in preventing CME. Compared with corticosteroids, bromfenac alone or plus a corticosteroid showed similar or better efficacy in minimizing changes in retinal thickness and macular volume. In diabetic cataract surgery patients, bromfenac was comparable or superior to corticosteroids for minimizing changes in retinal thickness; also, combination therapy with bromfenac and corticosteroids may be associated with smaller changes in foveal thickness, macular thickness, and macular volume versus monotherapy with either treatment alone in this patient population. In two randomized, double-masked, placebo-controlled clinical trials with bromfenac 0.07%, CME was reported as an adverse event in 0.5% and 1.5% of patients receiving bromfenac and placebo, respectively. In an analysis of four placebo-controlled trials with bromfenac 0.09%, macular edema was reported in 0.7% and 1.4% of patients receiving bromfenac and placebo, respectively. When evaluated as treatment for acute or chronic CME, bromfenac was associated with improvement in visual acuity and reduction in retinal thickness, but few studies are available. Overall, published data suggest that bromfenac is safe and effective when used to prevent or treat CME. Large-scale placebo-controlled trials and greater standardization of CME measures are needed to establish optimal bromfenac regimens for the prophylaxis and treatment of CME following cataract surgery.

Pseudophakic cystoid macular edema: update 2016

Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice.

Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac

Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria^®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.