Is topical better than standard steroid after cataract surgery?

Soft topical steroid application and standard steroid treatment demonstrate similar efficacy and safety in patients who underwent cataract surgery, reports a study.

Investigators performed a systematic search of the PubMed, Scopus, and Embase electronic databases for peer-reviewed published randomized controlled trials with clinical outcomes of topical steroid treatment after an uneventful cataract surgery.

The team then extracted and evaluated individual study data in a weighted pooled analysis, which included the grading of total anterior chamber (AC) inflammation, AC cells, AC flare, postoperative visual acuity (VA), intraocular pressure (IOP), and rate of adverse events (AEs).

A total of 508 studies were identified, of which seven met the eligibility criteria. Eligible studies involved 593 patients (age range, 3.7‒73.4 years) from five countries overall. Follow-up data were available for analysis at 1, 7, and 28 days after surgery.

No significant differences were noted in inflammatory activity measurements at every other follow-up (days 1 and 28 after surgery), except for a markedly lower grade of AC flare in the standard steroid group at day 7 (standardized mean difference, 0.26, 95 percent confidence interval, 0.05‒0.47; I², 0 percent).

In pooled analysis of IOP, standard steroid treatment produced a higher IOP at the 7-day visit, but both treatment groups showed similar IOP at other time points. Ocular AEs were also comparable between soft topic and standard steroid groups based on the qualitative analysis.

“The findings of this study suggest that for the average patient, both groups produce a comparable effect on both AC inflammation and postoperative IOP and VA,” the investigators said.