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

Full citation: Juthani VV, Clearfield E, Chuck RS. Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD010516. DOI: 10.1002/14651858.CD010516.pub2

Review aim
The aim of this review was to find out if topical non-steroidal anti-inflammatory drugs (NSAIDs) (alone or taken in combination with topical corticosteroids) or topical corticosteroids alone are better for controlling eye inflammation after cataract surgery. Cochrane review authors collected and analyzed all relevant studies to answer this question and found 48 studies.

Key messages
It is unclear whether NSAIDs or corticosteroids are better at treating eye inflammation after cataract surgery. There were many combinations of drugs and dosing regimens in the included studies. The majority of the studies did not provide data on inflammation..

What was studied in the review?
Cataract surgery is one of the most commonly performed eye surgeries. Eye inflammation is common after cataract surgery. If left untreated, this inflammation can cause many complications. NSAIDs or corticosteroids are typically used to control swelling after cataract surgery. These drugs work differently, so comparing their effects is necessary. Cochrane review authors compared the effectiveness of NSAIDs (alone or in combination with corticosteroids) versus corticosteroids alone for controlling swelling after cataract surgery.

What are the main results of the review?
We included 48 randomized controlled trials from 17 different countries. Fifteen studies compared an NSAID with a corticosteroid. Nineteen studies compared an NSAID plus corticosteroid versus a corticosteroid alone. Fourteen other studies had more than two study arms, with different combinations of NSAIDs and corticosteroids.

In comparing participants who received an NSAID with those who received a corticosteroid:

  • it was unclear whether the number of cells, which were a sign of inflammation inside the eye, was higher or lower

  • there was less flare (another sign of inflammation inside the eye, in which a beam of light becomes visible passing through the eye fluids, like the beam of a searchlight) in the back of the eye in the group that received only an NSAID

  • it was unclear whether there was a higher instance of swelling of the cornea, the clear window at the front of the eye which becomes misty if swollen, one month after surgery

  • there was a lower risk of developing cystoid macular edema (fluid and swelling in a part of the eye called the macula, the central part of the retina, a light-sensitive membrane at the back of the eye which is responsible for detailed vision and if so effected can make vision clouded and distorted) in the group that received only an NSAID

The included studies in this comparison did not provide enough information to look into sharpness of vision, how long participants needed treatment, side effects of the medications, or cost.

In comparing participants who received a combination of an NSAID plus a corticosteroid compared with those who received a corticosteroid alone:

  • there was a higher instance of corneal edema in the group that received a combination of the two types of medications

  • there was a lower risk of developing cystoid macular edema one week after surgery in the group that received a combination of the two types of medications

The included studies did not provide enough information to look into the amount of cells in the back of the eye, sharpness of vision, how long participants needed treatment, side effects of the medications or cost.

This review compared many different types of drugs, dosing, and treatments. We tried to look at all types of anti-inflammatory agents in this review. NSAIDs considered in this review were indomethacin, ketorolac, nepafenac, diclofenac, bromfenac, flurbiprofen, and pranoprofen. Corticosteroids included in this review were dexamethasone, prednisolone acetate, betamethasone, rimexolone, fluorometholone, and loteprednol. A future review with different outcomes may be more effective in determining whether NSAIDs or corticosteroids are better at treating swelling after cataract surgery.

How up-to-date is this review?
Cochrane review authors searched for studies that had been published up to 16 December 2016.


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