Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery

Abstract

Using topical NSAIDs may reduce the risk of developing macular oedema after cataract surgery, although it is possible that current estimates as to the size of this reduction are exaggerated. It is unclear the extent to which this reduction has an impact on the visual function and quality of life of patients. There is little evidence to suggest any important effect on vision after surgery. The value of adding topical NSAIDs to steroids, or using them as an alternative to topical steroids, with a view to reducing the risk of poor visual outcome after cataract surgery is therefore uncertain. Future trials should address the remaining clinical uncertainty of whether prophylactic topical NSAIDs are of benefit, particularly with respect to longer-term follow-up (at least to 12 months), and should be large enough to detect reduction in the risk of the outcome of most interest to patients, which is chronic macular oedema leading to visual loss.

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

“…A recent Cochrane review (Lim 2016) evaluated the proportion of people with a poor vision outcome due to CME at three months after cataract surgery, with poor vision defined as 6/9 or worse attributed to a diagnosis of CME. That study found low-certainty evidence that people who received topical NSAIDs in combination with steroid may have had a lower risk of poor vision due to macular edema at three months after cataract surgery compared to those taking corticosteroids alone (RR 0.40, 95% CI 0.27 to 0.61).…”

Cystoid macular oedema following cataract surgery: A review

“…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 …”

Anti‐inflammatory medication following cataract surgery: a randomized trial between preservative‐free dexamethasone, diclofenac and their combination

“…In addition, concerns of drug tolerability differences between NSAIDs and corticosteroids have emerged (Duong et al 2014;Kessel et al 2014;Kim et al 2015;Cardascia et al 2016;Coassin et al 2016;Grzybowski et al 2016;Lim et al 2016;Malik et al 2016;Duan et al 2017;Pollack et al 2017). The main interest revolves around the question whether the choice between topical corticosteroids or nonsteroidal anti-inflammatory drug (NSAID) affects postoperative inflammation or the risk of developing pseudophakic cystoid macular oedema (PCME; also, known as Irvine-Gass syndrome), and whether the choice has an impact on the speed of visual recovery and acuity gain.…”