Efficacy of a one-week course of topical bromfenac combined with corticosteroid for prevention of pseudophakic cystoid macular edema (PCME)

PURPOSE: To compare the efficacy of a 1-week postoperative regimen of topical bromfenac combined with corticosteroid versus corticosteroid monotherapy in preventing pseudophakic cystoid macular edema (PCME). METHODS: This retrospective study included 226 eyes of 226 patients who underwent uneventful phacoemulsification. Patients were divided into Group A (n = 158), receiving topical bromfenac 0.1% twice daily (BID) plus prednisolone acetate 1% (PDE) 6 times daily (6/d) or every 2 hours while awake (q2hrs), and Group B (n = 68), receiving PDE alone 6/d or q2hrs for the first postoperative week. Macular thickness was measured by Spectral-domain optical coherence tomography (SD-OCT) preoperatively and at postoperative week 5. PCME was defined as an increase in central subfield macular thickness (CSMT) with foveal cystoid changes. CSMT changes and PCME incidence were compared. A subgroup analysis evaluated the effect of PDE dosing frequency within the combination arm (6/d vs. q2hrs). RESULTS: Postoperative absolute and relative CSMT changes were significantly smaller in Group A (13.3 ± 13.0 μm, 5.6 ± 5.3%) than in Group B (27.0 ± 33.7 μm, 11.2 ± 14.3%; p = 0.002). The incidence of OCT-defined PCME was lower in Group A than in Group B (5.1% vs. 16.2%; OR = 0.28; 95% CI 0.11-0.72; p = 0.006). Among eyes developing PCME, the median CSMT increase was lower in Group A (38.5 μm) than in Group B (80.0 μm; p = 0.031). PCME incidence was numerically lower in [Bromfenac BID + PDE q2hrs] subgroup than [Bromfenac BID + PDE 6/d] subgroup (2.0% vs. 10.0%, OR = 0.19; 95% CI 0.04-0.79; p = 0.054). CONCLUSION: A one-week course of topical bromfenac combined with topical corticosteroid therapy was associated with smaller postoperative increases in macular thickness and a lower incidence of OCT-defined PCME than corticosteroid monotherapy after cataract surgery.