NSAIDs after cataract surgery don’t prevent long-term vision loss

This literature review found that topical nonsteroidal anti-inflammatory drugs (NSAIDs) after cataract surgery, either alone or in combination with corticosteroids, do not prevent long-term vision loss from cystoid macular edema (CME).

The review comes from a report by the Academy’s Ophthalmic Technology Assessment Committee, which evaluated the efficacy of prophylactic NSAIDs because it remains unclear if prophylactic NSAIDs do improve long-term outcomes, prevent the onset of CME or in some way decrease CME severity.

Based on a review of the available evidence, the authors found that NSAIDs were effective in reducing CME detected by angiographic or OCT, and  accelerated  short-term visual recovery after surgery (<3 months)  compared to placebo or corticosteroids with poor corneal penetration. However, there is no evidence that these drugs prevent long term CME-based vision loss (>3 months). The authors also found that there was no synergy between NSAIDs and corticosteroids to reduce long-term risk, and there was no evidence NSAID therapy provided better outcomes than equivalent dosing of a corticosteroid.

The review has some limitations, including no universally accepted method to report CME (either by angiograph or OCT) and varying corticosteroid formulations and concentrations. Still, the authors conclude that there is no evidence to support routine use of NSAIDs to prevent vision loss after cataract surgery.The authors also suggest that CME, which tends to resolve spontaneously, may be over diagnosed with OCT.