Cystoid macular edema prophylaxis in cataract surgery: A protocol for network meta-analysis

Objective: Cataracts are the leading cause of global preventable and treatable blindness. Cystoid macular edema (CME) is among the most common complications following cataract surgery. The development of CME impacts patients’ quality of life and has economic implications for patients and healthcare systems. The purpose of this review is to synthesize the evidence from randomized controlled trials evaluating patients receiving prophylactic treatment with nonsteroidal anti-inflammatory drugs or corticosteroid medications to determine the comparative effectiveness of each specific regimen on retinal thickness, visual acuity, the development of CME, patient quality of life, intraocular pressure and adverse events following uncomplicated, age-related cataract surgery performed by phacoemulsification. Methods: A systematic review and random effects Bayesian network meta-analysis (NMA) will be performed and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension statement for NMA. A comprehensive electronic search will be performed of the MEDLINE, EMBASE and CENTRAL databases, as well as of the ClinicalTrials.gov and World Health Organization International Clinical Trials Registries. Data will be collected and synthesized for seven pre-specified outcomes at 6 weeks and 3 months following surgery: i) change in central retinal thickness measured by optical coherence tomography (OCT), ii) best-recorded visual acuity iii) the rate of CME measured by OCT, and fluorescein angiography (FA) iv) the rate of patients experiencing clinically significant macular edema defined as the presence of CME and pre-specified thresholds for decreased visual acuity, v) patient quality of life, vi) intraocular pressure and vii) the number of patients experiencing one or more pre-specified adverse events. The certainty of evidence for each outcome will be assessed using GRADE NMA guidelines. Discussion: The results of this NMA will provide a comprehensive evaluation of the evidence for this critical question with significant clinical equipoise. Trial registration: Systematic Review Registration: PROSPERO Registration Number: CRD42024531150.