Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2

Laura H. P. Wielders*, Jan S. A. G. Schouten, Bjorn Winkens, Frank J. H. M. van den Biggelaar, Claudette A. Veldhuizen, Joaquim C. N. Murta, Willem R. O. Goslings, Thomas Kohnen, Marie-Jose Tassignon, Maurits V. Joosse, Ype P. Henry, Zoltan Z. Nagy, Alexander H. F. Rulo, Oliver Findl, Michael Amon, Rudy M. M. A. Nuijts, ESCRS PREMED Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

44 Citations (Web of Science)

Abstract

Purpose: To compare the efficacy of perioperative treatment strategies, in addition to topical bromfenac 0.09% and dexamethasone 0.1%, to reduce the risk for developing cystoid macular edema (CME) after uneventful cataract surgery in diabetic patients. Setting: Twelve European study centers. Design: Randomized clinical trial. Methods: Diabetic patients having phacoemulsification cataract surgery were randomly allocated to receive no additional treatment, a subconjunctival injection with 40 mg triamcinolone acetonide, an intravitreal injection with 1.25 mg bevacizumab, or a combination of both. The main outcomes were the difference in central subfield mean macular thickness, corrected distance visual acuity, and the incidence of CME and clinically significant macular edema within 6 and 12 weeks postoperatively. Results: The study comprised 213 patients. At 6 and 12 weeks postoperatively, the central subfield mean macular thickness was 12.3 tm and 9.7 pm lower, respectively, in patients who received subconjunctival triamcinolone acetonide than patients who did not (P =.007 and P =.014, respectively). No patient who received subconjunctival triamcinolone acetonide developed CME. Intravitreal bevacizumab had no significant effect on macular thickness. Conclusions: Diabetic patients who received a subconjunctival injection with triamcinolone acetonide at the end of cataract surgery had a lower macular thickness and macular volume at 6 and 12 weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect. (C) 2018 ASCRS and ESCRS.
Original languageEnglish
Pages (from-to)836-847
Number of pages12
JournalJournal of Cataract and Refractive Surgery
Volume44
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018
Event35th Congress of the European-Society-of-Cataract-and-Refractive-Surgeons (ESCRS) - Lisbon, PORTUGAL, Lisbon
Duration: 1 Apr 2018 → …

Keywords

  • INTRAVITREAL BEVACIZUMAB
  • TRIAMCINOLONE
  • PHACOEMULSIFICATION
  • INJECTION
  • RANIBIZUMAB
  • RETINOPATHY
  • THICKNESS
  • RETINA
  • RISK

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