To assess the efficacy of topical NSAIDs as adjunctive therapy for diabetic macular edema (DME).
Approach:
Study Design: Systematic review and meta-analysis of six studies involving 446 patients and 892 eyes.
Interventions: Topical NSAIDs (bromfenac, ketorolac, nepafenac) administered alone or with intravitreal anti-VEGF therapy.
Endpoints: Primary endpoint was best-corrected visual acuity (BCVA); secondary endpoints included central macular thickness (CMT) and macular volume.
Key Findings:
Pooled analysis showed a statistically significant improvement in BCVA with topical NSAIDs, with a mean difference of 1.82 ETDRS letters, although the clinical relevance of this improvement is uncertain as it is below the standard change deemed clinically meaningful.
Meta-analysis indicated a trend toward greater CMT reduction in NSAID-treated eyes, but it did not reach statistical significance.
No meaningful benefit was observed for macular volume reduction between treatment groups.
Interpretation:
The evidence does not support a clear anatomical advantage of topical NSAIDs in DME management.
Limitations:
High heterogeneity across studies in anatomical outcomes.
Insufficient evidence to define the long-term role of NSAIDs in treatment algorithms.
Conclusion:
The current evidence does not support a clear anatomical advantage or define the long-term role of topical NSAIDs in treatment algorithms.
For ASCs seeking long-term stability, panelists at the OOSS symposium agreed that success will depend on understanding the full range of anesthesia delivery models and choosing the approach that best aligns with each organization’s goals and resources.
