Both NSAIDs Alone and NSAIDs Plus Steroids Reduce Post–Cataract Surgery Complications

Using postoperative medications to reduce complications after cataract surgery has been studied in systematic reviews and meta-analyses. In these earlier analyses, nonsteroidal anti-inflammatory drugs (NSAIDs) were found to be more effective than corticosteroids in preventing cystoid macular edema (CME) and controlling postoperative inflammation, but to date no practice patterns or guidelines have reflected these data. This meta-analysis aimed to compare the efficacy and safety of NSAID monotherapy vs corticosteroid monotherapy vs the combination of NSAIDs and corticosteroids.

Study Design

Nineteen studies, featuring a total of 3374 patients (3638 eyes) who were treated after cataract surgery with NSAIDs alone, corticosteroids alone, or both, were included. LogMAR visual acuity and flare values obtained by laser flare photometry were reported; subjective measurements were not included. Cystoid macular edema was identified by fluorescein angiography and/or OCT, and macular thickness was measured with OCT.

Outcomes

Combination therapy and NSAID monotherapy were more effective at controlling inflammation than corticosteroid monotherapy. Favorable BCVA values and a lower incidence of macular edema were seen with combination therapy at 1–2 months post-surgery than with corticosteroid monotherapy, while NSAID monotherapy had more favorable flare values and thinner central macular thickness at the post-op day 7, day 14, and weeks 4–6 time points.

Limitations

Different time points were combined for the later time point data analyses. The medications used were of different concentrations and durations; therefore, combination groups were difficult to compare to the NSAID-alone groups.

Clinical Significance

The question of the necessity of NSAIDs post–cataract surgery has been discussed for many years. Results from this meta-analysis suggest that the combination of corticosteroids and NSAIDs or NSAIDs alone both offer some reduction in inflammation and the incidence of macular edema after surgery, particularly when compared with corticosteroids alone. However, the higher cost of NSAIDs may affect the use of these medications, given that the incidence of these postsurgical complications is low.

Financial Disclosures: Dr. Leela Raju discloses financial relationships with RPS Diagnostics (Equity/Stock Holder - Private).