Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis

Abstract

ObjectiveTopical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.DesignSystematic review and meta-analysis.Data sourcesMedline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references’ lists of the relevant articles.Eligibility criteriaRandomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.Data extraction and synthesisTwo independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.ResultsWe included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).ConclusionWith low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.

2021 Survey of Keratoplasty Postoperative Steroid Management

“…4 The continued popularity of prednisolone is interesting given that it is less potent than difluprednate. Although the 2 steroids have not been directly compared as a means of preventing corneal graft rejection, a 2018 systematic review and meta-analysis 14 of 6 RCTs showed that difluprednate was superior to prednisolone acetate during the first 2 weeks postcataract surgery. These results warrant further investigation of steroid use for keratoplasty outcomes.…”

“…16 The systematic review and meta-analysis from 2018 also reported no statistically significant difference in high IOP events between both drugs across studies and deemed both agents safe for IOP rise. 14…”

Therapeutic Efficacy of Difluprednate 0.05% Versus Prednisolone Acetate 1% in Controlling Inflammation and Macular Oedema Following Phacoemulsification: An Optical Coherence Tomography-Based Study

“…Newer techniques in phacoemulsification and the advent of safer topical steroids and non-steroidal drugs (NSAIDs) administration have led to quick visual rehabilitation after cataract surgery. Yet, postoperative inflammation in the form of AC reaction and CME continues to be the major factors causing sub-optimal visual outcomes [ 27 ]. Corticosteroids play a vital role in the treatment of this inflammation by inhibiting the release of arachidonic acid from cell membrane phospholipids and prevent the production of leukotrienes and prostaglandins.…”

“…Corticosteroids play a vital role in the treatment of this inflammation by inhibiting the release of arachidonic acid from cell membrane phospholipids and prevent the production of leukotrienes and prostaglandins. Older potent topical corticosteroids like prednisolone acetate and dexamethasone are now being replaced with newer and safer steroids like difluprednate and fluorometholone [ 27 ]. The known advantages of difluprednate related to its better patient compliance over prednisolone are its better bioavailability, enhanced penetration and dose uniformity apart from being preservative-free.…”

“…They also found difluprednate to be superior in terms of corneal clarity at one day (OR=2.6, p=0.02) and one week after phacoemulsification surgery (OR=1.96, p=0.0007). However, both drugs were equally effective at one month [ 27 ].…”