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

Juthani, Viral V.; Clearfield, Elizabeth; Chuck, Roy S.

doi:10.1002/14651858.cd010516.pub2

Cited by 76 publications

(71 citation statements)

References 96 publications

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“…A report by the American Academy of Ophthalmology in 2015 advised that peri-operative topical NSAIDs are effective in reducing the occurrence of pseudophakic CMO, may increase the speed of visual recovery postoperatively in diabetic patients, but do not alter long-term visual outcomes beyond 3 months [5]. [6,7,9,14,26,[31][32][33][34][35][36][37]. A recent review of CMO by McGhee's group in Auckland concluded that "there are limited evidence-based clinical studies available regarding successful treatment strategies, and there is substantial inconsistency between studies in terms of defining successful outcome measures, with some focusing on improvements as measured by OCT or fluorescein angiography vs visual acuity outcomes" [29].…”

Section: Discussionmentioning

confidence: 99%

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

Erikitola

Siempis

Foot

et al. 2020

Eye

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Purpose Post-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients. Methods A Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation. Results Fourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44-86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2-0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270-788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1-0.3) with average mean CRT of 327microns (245-488). Conclusions We identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.

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Section: Discussionmentioning

confidence: 99%

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

Erikitola

Siempis

Foot

et al. 2020

Eye

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“…Similarly, two recent Cochrane systematic reviews studied the effectiveness of topical NSAIDs, either alone or in addition to topical corticosteroids, vs topical corticosteroids alone. Although they found low certainty evidence to suggest some risk reduction of PCMO using NSAID (with or without corticosteroids) there was no definite evidence to suggest the superiority of NSAIDs with or without adjunctive corticosteroids in relation to the prophylaxis of PCMO …”

Section: Prophylaxismentioning

confidence: 99%

“…Although they found low certainty evidence to suggest some risk reduction of PCMO using NSAID (with or without corticosteroids) there was no definite evidence to suggest the superiority of NSAIDs with or without adjunctive corticosteroids in relation to the prophylaxis of PCMO. 33,34 In contrast, a systematic review of 15 randomized controlled trials (RCTs) by Kessel et al 31 identified evidence to support the preferential use of topical NSAIDs compared to topical corticosteroids, although when this prophylactic treatment should be initiated was not evaluated. Interestingly, where imaged by fluorescein angiography or OCT at 4 to 5 weeks PCMO was reported to be six to seven times more prevalent in those randomized to topical corticosteroids compared to topical NSAIDs (25.3% vs 3.8%).…”

Section: Prophylaxismentioning

confidence: 99%

Cystoid macular oedema following cataract surgery: A review

Han

Patel

Squirrell

et al. 2019

Clinical Exper Ophthalmology

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Pseudophakic cystoid macular oedema (PCMO) remains a significant cause of compromised postoperative vision in contemporary cataract surgery. Well‐established risk factors include intraoperative complications such as posterior capsule rupture and preoperative factors including: diabetes mellitus, uveitis, retinal vein occlusion, epiretinal membrane. The role of topical glaucoma medications in PCMO continues to be debated. Current treatment strategies largely target suppression of inflammation. Topical NSAIDs remain the mainstay in prophylaxis and treatment of PCMO. Topical corticosteroids are commonly used as monotherapy or in combination with NSAIDs. Unfortunately, high‐quality trials are notably lacking for other PCMO treatment modalities such as: periocular corticosteroids, orbital floor triamcinolone, intravitreal triamcinolone, corticosteroid implants, intravitreal bevacizumab and pars‐plana vitrectomy. A lack of consistency in defining PCMO and resolution of PCMO explains why even large systematic reviews may come to contradictory conclusions. This review explores the varied contemporary evidence‐base in relation to the aetiology, diagnosis, prophylaxis and treatment of PCMO.

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“…Although the review authors 7 included 48 trials, none of the trials reported data for the review’s prespecified primary outcome: proportion of patients with intraocular inflammation at 1-week follow-up after surgery. Modifying the outcome to include mean amount of inflammation at 1-week follow-up would have allowed only 7 trials to be eligible.…”

mentioning

confidence: 99%

“…Including other follow-up time points would have allowed only 4 additional studies to be eligible. 7 Studies have demonstrated that inconsistent outcome use is also a problem in AMD, 8 glaucoma, 9 uveitis, 10 allergic conjunctivitis, 11 and intermittent exotropia. 12 …”

mentioning

confidence: 99%

Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases

et al. 2017

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IMPORTANCE Suboptimal overlap in outcomes reported in clinical trials and systematic reviews compromises efforts to compare and summarize results across these studies.OBJECTIVES To examine the most frequent outcomes used in trials and reviews of the 4 most prevalent eye diseases (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) and the overlap between outcomes in the reviews and the trials included in the reviews. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study examined all Cochrane reviews that addressed AMD, cataract, DR, and glaucoma; were published as of July 20, 2016; and included at least 1 trial and the trials included in the reviews. For each disease, a pair of clinical experts independently classified all outcomes and resolved discrepancies. Outcomes (outcome domains) were then compared separately for each disease. MAIN OUTCOMES AND MEASURES Proportion of review outcomes also reported in trials and vice versa.RESULTS This study included 56 reviews that comprised 414 trials. Although the median number of outcomes per trial and per review was the same (n = 5) for each disease, the trials included a greater number of outcomes overall than did the reviews, ranging from 2.9 times greater (89 vs 30 outcomes for glaucoma) to 4.9 times greater (107 vs 22 outcomes for AMD). Most review outcomes, ranging from 14 of 19 outcomes (73.7%) (for DR) to 27 of 29 outcomes (93.1%) (for cataract), were also reported in the trials. For trial outcomes, however, the proportion also named in reviews was low, ranging from 19 of 107 outcomes (17.8%) (for AMD) to 24 of 89 outcomes (27.0%) (for glaucoma). Only 1 outcome (visual acuity) was consistently reported in greater than half the trials and greater than half the reviews. CONCLUSIONS AND RELEVANCEAlthough most review outcomes were reported in the trials, most trial outcomes were not reported in the reviews. The current analysis focused on outcome domains, which might underestimate the problem of inconsistent outcomes. Other important elements of an outcome (ie, specific measurement, specific metric, method of aggregation, and time points) might have differed even though the domains overlapped. Inconsistency in trial outcomes may impede research synthesis and indicates the need for disease-specific core outcome sets in ophthalmology.

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

Cited by 76 publications

References 96 publications

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery—a Scottish Ophthalmological Surveillance Unit study

Cystoid macular oedema following cataract surgery: A review

Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases

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