Prospective, randomized trial of oral piroxicam in the prophylaxis of postoperative cystoid macular edema.

One hundred and seventy-eight patients undergoing uncomplicated cataract extraction with posterior chamber intraocular lens insertion completed a prospective, randomized, controlled trial of oral piroxicam in the prophylaxis of postoperative cystoid macular edema (CME), with a 1-year follow up. The incidence of "visually significant" CME, the mean interval to onset following surgery, clinical severity, recurrence rate, and the time to achieve best corrected visual result were unaffected by a 17-day piroxicam course. Oral steroid CME treatment produced a rapid response, but could not be shown to change the ultimate visual results. High-performance liquid chromatography analysis of aqueous humor obtained at cataract surgery suggested that piroxicam's pharmacokinetics might be a factor in this lack of response; the large number of potential inflammatory mediators uninfluenced by cyclo-oxygenase inhibition also may implicate piroxicam pharmacodynamics.