Prevention of macular edema in patients with diabetes after cataract surgery

To evaluate the efficacy of topical steroids ± nonsteroidal antiinflammatory drugs (NSAIDs), depot steroids, and antivascular endothelial growth factors (anti-VEGFs) in preventing pseudophakic cystoid macular edema (PCME) after cataract surgery in patients with diabetes, a systematic literature search for randomized controlled trials published after 1990 was carried out in Cochrane, EMBASE, and PubMed databases. A meta-analysis was performed using risk ratios for PCME as the primary outcome and visual acuity, macular thickness, and adverse events as the secondary outcomes. Topical steroids in combination with NSAIDs prevented 75.8% of PCME events compared with steroids alone in diabetic patients without preoperative diabetic macular edema; depot + topical steroids either alone or in combination with NSAIDs were superior to topical steroids ± NSAIDs alone; however, the incidence of elevated intraocular pressure was increased. Anti-VEGF + topical steroids ± NSAIDs had no influence on PCME prevalence in patients with diabetes mellitus.