Pharmacologic therapy of aphakic cystoid macular edema. A review

Pharmacologic therapy of aphakic cystoid macular edema (ACME) in the past has included the use of topical, periocular, and systemic corticosteroids as well as inhibitors of prostaglandin synthesis. Preliminary studies have suggested a beneficial effect of systemic corticosteroids on ACME, although it has been said that this effect is temporary and that recurrences are common. To date, no adequate therapeutic or prophylactic trial of topical, periocular, or systemic corticosteroids for ACME has been performed. Several elegant clinical trials have been done to study the effects of indomethacin, a prostaglandin (PG) synthesis inhibitor, on the incidence of ACME. It seems likely that topical, and perhaps systemic, indomethacin is effective in reducing the incidence of angiographically proved ACME. To date, however, no trial has demonstrated a sustained effect of topical or systemic PG synthesis inhibitors on ACME or visual acuity. Further studies of the role of PG synthesis inhibitors (especially topical agents) in the therapy of ACME are necessary. In addition, further efforts should be made to determine the efficacy of the use of PG synthesis inhibitors in combination with corticosteroids.