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The comparative efficacy and safety of topical non-steroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis

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Abstract

Purpose

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of anti-inflammatory drugs that are used in ophthalmologic surgery. These drugs do not have a steroid structure, but can inhibit surgery-induced miosis, anterior chamber inflammation, and cystoid macular edema (CME). However, the application of NSAIDs remains controversial. Therefore, we performed a meta-analysis to assess the efficacy and safety of NSAIDs for the treatment of anterior chamber inflammation after cataract surgery.

Methods

Relevant articles were identified from the PubMed, Embase, and Cochrane databases up to October 2016. The therapeutic effect of NSAIDs on anterior chamber inflammation was evaluated. The important outcomes of overall anterior chamber inflammation, freedom from ocular pain, and treatment-related/serious ocular adverse events were analyzed by using a random-effects network meta-analysis. The quality of evidence was assessed via the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.

Results

A total of 19 trials assessing 7,234 patients were included in our meta-analysis. Diclofenac was the most likely to improve anterior chamber inflammation after cataract surgery, followed by nepafenac, ketorolac, bromfenac, and flurbiprofen. Nepafenac was most likely to improve postoperative ocular pain relief, followed by bromfenac and ketorolac. Our analysis of treatment-related/serious ocular adverse events revealed that piroxicam was most likely to have the fewest related adverse events, but the robustness of this finding was low. Diclofenac was another near-ideal drug, followed by nepafenac, bromfenac, and ketorolac.

Conclusions

NSAIDs are effective drugs compared to placebos for the relief of anterior chamber inflammation. Furthermore, diclofenac, nepafenac, ketorolac, and bromfenac demonstrated relatively greater significant effects than those of other NSAIDs.

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Authors’ contributions

PD conceived of the study; PD and YL searched the literature and collected the data; YL performed the statistical analyses; PD drafted the manuscript; JwL reviewed the manuscript. All authors have read and approved the final paper.

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Authors and Affiliations

  1. Department of Ophthalmology, The Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

    Ping Duan, Yong Liu & Jiawen Li

  2. Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, No. 30 Gaotanyan Main Street, Shapingba District, Chongqing City, 400038, China

    Ping Duan, Yong Liu & Jiawen Li

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  1. Ping Duan
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Correspondence to Jiawen Li.

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This study was funded by the National Natural Science Foundation of China (Grant No. 81400418).

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Duan, P., Liu, Y. & Li, J. The comparative efficacy and safety of topical non-steroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis. Graefes Arch Clin Exp Ophthalmol 255, 639–649 (2017). https://doi.org/10.1007/s00417-017-3599-8

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