NSAIDs, combination therapies safe, effective for cataract surgery aftercare

Nonsteroidal anti-inflammatory drugs (NSAIDs) and combination treatments provide a more effective and safer alternatives to corticosteroid in the postoperative management of patients who have undergone cataract surgery, according to a study.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials of patients undergoing age-related cataract surgery treated with corticosteroids, NSAIDs, or a combination. Multiple online databases were searched for relevant articles.

Nineteen studies were identified and included in the meta-analysis. These studies involved 3,473 patients (3,638 eyes) who underwent cataract surgery and were subsequently treated with NSAIDs (n=1,479), corticosteroids (n=1,307), or a combination (n=687).

Combination treatment yielded beneficial effects on best-corrected visual acuity compared with corticosteroids over 4 to 6 weeks after cataract surgery (mean difference [MD], –0.01 logMAR, 95 percent confidence interval [CI], –0.02 to –0.01, I²=0 percent).

Meanwhile, NSAIDs was associated with more favourable flare values than corticosteroids at day 7 (MD, –9.17 photons/ms, 95 percent CI, –16.52 to –1.82, I²=94 percent), day 14 (MD, –5.23 photons/ms, 95 percent CI, –8.35 to –2.11, I² = 94 percent), and at 4 to 6 weeks (MD, –1.62 photons/ms, 95 percent CI, –3.03 to –0.20, I²=93 percent).

At 4 to 8 weeks postoperatively, patients who received postoperative NSAIDs had lower central macular thickness compared with those who received corticosteroids (MD, –13.26 µm, 95 percent CI, –18.66 to –7.86; I²=81 percent).

Compared with corticosteroids, NSAIDs and combination treatment were associated with a lower incidence of central macular edema (NSAIDs: odds ratio [OR], 0.16, 95 percent CI, 0.07–0.35; I²=61 percent; combination therapy: OR, 0.21, 9 percent CI, 0.10–0.45; I²=31 percent) at 4 to 8 weeks postoperatively.