Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study

Abstract

Purpose To compare the anti-inflammatory efficacy of ketorolac of tromethamine 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CME) after small-incision cataract extraction.

Topical Nonsteroidal Anti-inflammatory Drugs and Cataract Surgery

“…While this paper was under review, Tzelikis et al 40 reported that prophylactic use of nonsteroidal anti-inflammatory drugs, ketorolac (0.4%) and nepafenac (0.1%), were not efficacious in preventing macular edema compared with placebo after uneventful cataract surgery when evaluated by OCT in a prospective randomized study, which corroborates the findings of this evidence-based review.…”

Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery

“…Some studies included a group of participants who received other types of cataract surgery, in which case we used only the data from the participants who underwent phacoemulsification. The studies were conducted in 17 different countries: three in Brazil (Ticly 2014; Tzelikis 2015; Zanetti 2012), two in Canada (Almeida 2008; Almeida 2012), four in China (Chen 2015; Li 2011; Wang 2013; Zhang 2008), one in Cuba (Ruiz Rodríguez 2011), one in Egypt (Elsawy 2013), one in France (Adam 2005), two in Germany (Hessemer 1996; Schmitt 1995), two in Greece (Chatziralli 2011; Moschos 2012), one in India (Sahu 2015), one in Iran (Entezari 2016), seven in Japan (Asano 2008; Endo 2010; Kato 1998; Miyake 2007; Miyake 2011; Miyanaga 2009; Shimazaki 1996), one in Mexico (Cervantes-Coste 2009), one in South Korea (Jung 2015), two in Sweden (Laurell 2002; Zaczek 2014), one in Thailand (Trinavarat 2003), two in Turkey (Dal 2014; Yavas 2007), and seven in the United States (Duong 2014; el-Harazi 1998; Holzer 2002; Mathys 2010; Singh 2012; Solomon 2001; Wittpenn 2008). Investigators of nine studies did not report in which country the trial had been conducted (Bucci 2001; Demco 1997; Donnenfeld 2006; Guzey 2000; McColgin 1999; Mulet 2001; Ostrov 1997; Roberts 1995; Voudouri 2002).…”

“…Nineteen studies compared a combination of an NSAID plus a corticosteroid with a corticosteroid only (Adam 2005; Almeida 2008; Cervantes-Coste 2009; Chatziralli 2011; Chen 2015; Dal 2014; Elsawy 2013; Entezari 2016; Li 2011; Mathys 2010; McColgin 1999; Moschos 2012; Ruiz Rodríguez 2011; Shimazaki 1996; Singh 2012; Ticly 2014; Wittpenn 2008; Zaczek 2014; Zhang 2008). Fourteen other studies had three or more arms and had such combinations as an NSAID alone versus a corticosteroid alone versus a combination (Hessemer 1996; Miyanaga 2009; Schmitt 1995); multiple NSAIDs compared with each other and versus a corticosteroid (el-Harazi 1998; Mulet 2001; Zanetti 2012); an NSAID versus a corticosteroid versus a different corticosteroid (Ostrov 1997; Trinavarat 2003); and multiple combinations of an NSAID plus a corticosteroid against each other with a corticosteroid-only arm in addition (Almeida 2012; Donnenfeld 2006; Jung 2015; Sahu 2015; Tzelikis 2015; Yavas 2007). NSAIDs given in the studies were indomethacin, ketorolac, nepafenac, diclofenac, bromfenac, flurbiprofen, and pranoprofen.…”

“…Some of the studies collected data on the outcomes we intended to include, but these data were reported only in figures from which we were unable to extract the numbers needed for a meta-analysis; these studies are noted in the table. For the first primary outcome of this review, the proportion of participants with intraocular inflammation measured by presence of macular edema, only 4/48 (8%) of the included studies reported data (Chatziralli 2011; Singh 2012; Trinavarat 2003 and Tzelikis 2015). Of the four studies, three reported the data in a format that we could not use for meta-analysis (data was presented either in a figure only, at time points that were not of interest in this review, or used a different definition of macular edema).…”

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

“…Two studies [16, 21] included 141 patients in the Nepafenac group and 145 patients in the Ketorolac group described the perioperative CMT. For both preoperative CMT and postoperative CMT at 1 week and 1 month, fixed-effect models were used as no heterogeneity was detected.…”