| Background and ObjectiveMacular edema (ME) is the common cause of low vision atter phacoemulsification[1].ME can be divided into cystoid edema and diffuse edema according to themorphology[2], Cystoid edema manifested as multiple cysts in the outer plexiform layer,with cysts interval and intracavitary liquid low reflected signal, and diffuse edemamanifested as the macular retina widely thickening. According to the severity, ME canbe divided into mild, moderate and severe degrees[3]，Mild ME refers to a certaindegree of posterior pole retinal thickening and hard exudatest far away from the centerof the macula；Moderate ME refers to a certain degree of posterior pole retinalthickening and hard exudates close to but not involving the center of the macula; SevereME means retinal thickening and hard exudates involving the center of the macula。There was a study which reported that the increase of macular thickness happened60 days to6months after phacoemulsufucation,[4-6]。In Hee MR’s study, no matter with orwithout cystoid edema, the vision abnormality of cataract patients after surgery isclosely related to the change of macular foveal retinal thickness[7].As to the patientswith cystic macular edema (CME), foveal thickness measured by optical coherencetomography (OCT) and visual acuity was negatively correlated[8-9].OCT is a new type of optical detection technology， which is non-contact andnon-invasive, and can be used to scan the fundus structure[27]. The resolution of OCT is10times more than the B-ultrasound and5times more than the UBM. It can detects theretina effusion much earlier than the fundus fluorescein angiography,and canobjectively assess the thickness of retina and the height of effusion. The patience shouldbe examined by the OCT before the cataract surgery when the lens is transparent andthe economic conditions are permitted, so the visual function can be accessed by thedoctors preoperatively. In developed countries,OCT examination must be done beforecataract surgery, for it can clearly show some fundus abnormality, which prompted thedoctors to carry out some necessary treatments before the cataract surgery.There are two main reasons of the inflammatory response after cataract surgery，the oneis the mechanical injury coursed by surgical operation, and the other is the foreign bodyreaction of the intraocular lens and the residual lens epithelial. Both the two factorsproduce prostaglandin (PG), which destructs the blood aqueous barrier, and causes theinflammatory response after cataract surgery[10]. With the development of surgicalmethods and medical equipments, the anterior chamber reaction afterphacoemulsification has been significantly reduced. The focus on medication beforeand after the surgery has shifted to the inhibition of PG’s synthesis. Non-steroidalanti-inflammatory drugs (NSAIDs) play an anti-inflammatory, analgesic and antipyreticeffect by inhibiting cyclooxygenase’s synthesis and preventing peanut arachidonic acidfrom converting to PG[11]。At home and abroad, many scholars have studied the application of NSAIDs in cataract surgery. The researchs mainly include:(1) Theeffectiveness of NSAIDs on the occurrence of macular edema after cataractsurgery[12-15];(2) Compare the effectiveness of steroid eye drops and non-steroidal eyedrops on macular when used after cataract surgery[16-19];(3) Compare the effectivenessof different non-steroidal eye drops on macular when used after cataract surgery[20];(4)Compare the effectiveness of non-steroidal eye drops on macular when used before andafter cataract surgery[21-23];(5) Compare the effectiveness of non-steroidal eye drops onmacular when used in different time before cataract surgery[24-26]and so on. This studyaims to compare the preventive effectiveness of oral non-steroidal anti-inflammatorydrugs and non-steroidal anti-inflammatory eye drops on macular edema when usedbefore uneventful phacoemulsification surgeryMethods115patients (135eyes)who were going to undergo phacoemulsification wererandomly divided into four groups, which are group A (31cases,31eyes), group B (26cases,32eyes), group C (30cases and42eyes) and group D(28cases,30eyes).Group Awas given ibuprofen sustained-release capsules3days before surgery, group B wasgiven Pula ibuprofen eye drops3days before surgery, group C was given Pulaibuprofen eye drops after surgery and D group was not given any non-steroidalanti-inflammatory drugs. All groups except D were given Tobradex and Pula ketoprofeneye drops and D group was only given Tobradex eye drops postoperatively. Thepatience were fellowed up to be examined by optical coherence tomography beforeoperation and in the first day, the first week, the second week, the fourth week, the sixthweek, the twelfth week after operation. The occurrence and development of macularedema would be recorded. Results（1）The differences of the incidence of macular edama between groups were notstatistically significant in the first day, the first week, the second week and the fourthweek, and was statistically significant in the sixth week and the twelfth week (P<0.05);（2）In the sixth week, the differences of the incidence of macular edama betweengroups were statistically significant. The incidence of macular edema in group D wassignificantly higher than the other three groups (P <0.05). There were no significantstatistic differences in the incidence of macular edama in the A, B, C groups;（3）In thetwelfth week, the differences of the incidence of macular edama between groups werestatistically significant. The incidence of macular edema in group C and group D wassignificantly higher than the other two groups (P<0.05). There were no significantstatistic differences in the incidence of macular edama between groups A and B, as wellas groups C and D;（4）In the postoperative period, there were no significant statisticdifferences in the central subfield thickness (CST), cube volume (CV) and cube averagethickness (CAT), and no correlations between CST and best corrected visual acuity(BCVA)、CV and BCVA as well as CAT and BCVA.Conclusion（1）The application of non-steroidal anti-inflammatory drugs before surgery wouldmore significantly reduce the incidence of macular edema than postoperativeapplication;（2）Oral non-steroidal anti-inflammatory drugs would not be better thannon-steroidal anti-inflarmnatory eye drops on the the prevention of macular edemawhen used before uneventful phacoemulsification surgery. |
PDF Full Text Request