A comparative study of various topical nonsteroidal anti-inflammatory drugs to steroid drops for control of post cataract surgery inflammation

Abstract

Background:Postoperative inflammation continues to be a cause of patient discomfort, delayed recovery, and in some cases, suboptimal visual results. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid are commonly used in the management and prevention of noninfectious ocular inflammation following cataract surgery.Aims:The aim was to study the safety and efficacy of various NSAIDs drops for control of postoperative inflammation following cataract surgery and compare with steroid eye drops in a patient following cataract surgery.Subjects and Methods:Totally, 200 patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly assigned to receive either nepafenac 0.1% 3 times daily, bromfenac 0.09% twice daily, ketorolac 0.5% 4 times daily for 1 month or 1% prednisolone eye drops as their postoperative anti-inflammatory medication with 50 cases in each group. The patients were examined at the 1st day (baseline), 1st week, 2nd week, and 4th week after surgery. Postoperative inflammation was evaluated subjectively by intraocular pressure, slit-lamp assessment of signs of inflammation, including conjunctival hyperemia, ocular pain, and aqueous cells and flare.Statistical Analysis:Statistical analysis was performed by the SPSS program for Windows, version 17.0.Results and Conclusions:In our study, we found that prednisolone 1% was more effective in controlling postoperative intraocular inflammation in terms of reducing anterior chamber cells and flare. We found that ketorolac 0.5% and nepafenac 0.1% were equally effective in controlling postoperative ocular pain and inflammation. All four drugs are effective in controlling post cataract surgery ocular inflammation. Intraocular inflammation is best controlled with prednisolone 1%, while ocular pain and hyperemia are better controlled with NSAIDs in the early postoperative periods.

Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey

“…Since the literature search included studies up to June 2015, one additional RCT should be added in the discussion. Malik et al 47 evaluated the efficacy of nepafenac 0.1%, bromfenac 0.09%, ketorolac 0.5% or 1% prednisolone, randomly assigned, in 200 patients after phacoemulsification. They found a lower number of anterior chamber cells and flare from the first postoperative day to the second week in patients treated with prednisolone.…”

Comparison of the efficacy and patients’ tolerability of Nepafenac and Ketorolac in the treatment of ocular inflammation following cataract surgery: A meta-analysis of randomized controlled trials

“…Among them, another 10 studies were excluded for unrelated or insufficient data. Finally, 11 studies were selected for this meta-analysis (Fig 1) [3, 7, 14–17, 20–24]. The dataset consisted of 1165 patients, including 1175 cataract surgeries.…”

“…Together, five studies [3, 7, 14–17, 20–24] included 262 patients in Nepafenac group and 274 patients in Ketorolac group described the perioperative BCVA (log MAR scale) respectively.…”

“…Three studies [3, 17, 20] included 167 patients in the Nepafenac group and 175 patients in the Ketorolac group described the postoperative anterior chamber inflammation grade. When pooling the data of anterior chamber inflammation grade at postoperative 1 day, 1 week and 1 month, fixed-effect models were used as Chi-squared test manifested no heterogeneity.…”

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

“…The efficacy of DEX, IND and CIP was also evaluated determined by AC inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing in patients after cataract surgery. Currently, comparative studies of anti-inflammatory drugs for control of post cataract surgery AC inflammation have been proposed in clinic (21)(22)(23). Previous study has evaluated the efficacy of intracameral dexamethasone predisposes to glaucoma after pediatric cataract surgery (24).…”