Indomethacin in the treatment of postoperative cystoid macular edema

The author postulates that prostaglandins and other inflammatory mediators synthesized in the ocular tissues during surgery play a role in the manifestation of postsurgical cystoid macular edema (CME). Thus, topical indomethacin was used before and shortly after intracapsular lens extraction and retinal detachment surgery, and was found to reduce the incidence of postoperative CME. Radioimmunoassay measurements of prostaglandins in subjects immediately after lens extraction and also in subjects with vitreous incarceration to anterior segments and persistent CME showed substantially elevated levels of prostaglandins. These findings indicate that inflammatory mediators including prostaglandins play a role in the manifestation of postsurgical CME. The factors that make CME chronic and the rationale for using vitrectomy in persistent CME are discussed in relation to the prostaglandin theory. This review primarily covers the author's previous studies.