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Review of the Evidence for Topical Nonsteroidal Anti-inflammatory Drugs Post-cataract Surgery

  • Cataract (CE Starr and A Brissette, Section Editors)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this article, we review the recent literature surrounding the use of topical nonsteroidal anti-inflammatory drops for prophylaxis of cystoid macular edema following uncomplicated cataract surgery.

Recent Findings

As has been found with past research, most recent studies suggest that topical NSAIDs may help reduce the incidence of postoperative cystoid macular edema. The effect may be minimal in patients at low risk for macular edema, and more pronounced in those at high risk. The evidence suggests that the effect is maximized when used in combination with topical corticosteroids.

Summary

Although there remain several limitations to the research on this topic that restrict our ability to draw firm conclusions, the bulk of the evidence supports the use of postoperative topical NSAIDs for cataract surgery in patients at high risk for macular edema. However there is no consensus regarding the ideal choice of NSAID, or the ideal dosing regimen following surgery.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC, et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology. 2016;123(2):316–23.

    Article  Google Scholar 

  2. Bakri SJ. Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(11):2159–68.

    Article  Google Scholar 

  3. Henderson B, Yong Kim J, Ament C, Ferrufino-Ponce Z, Gabowska A, Cremers S. Clinical pseudophakic macular edema: risk factors for development and duration after treatment. J Cataract Refract Surg. 2007;33:1550–8.

    Article  Google Scholar 

  4. Vukicevic M, Gin T, Al-Qureshi S. Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phaco-emulsification cataract surgery. Clin Exp Ophthalmol. 2012;40:282–7.

    Article  Google Scholar 

  5. •• McCafferty S, Harris A, Kew C, et al. Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol. 2017;17:16 This prospective, randomized control trial showed a significantly lower rate of PCME in high-risk patients receiving nepafenac versus placebo; however, there was no significant difference in PCME rate in patients that were low risk.

    Article  Google Scholar 

  6. Higashide T, Sugiyama K. Use of viscoelastic substance in ophthalmic surgery-focus on sodium hyaluronate. Clin Ophthalmol. 2008;2:21–30.

    Article  CAS  Google Scholar 

  7. Miyake K, Ibaraki N. Prostaglandins and cystoid macular edema. Surv Ophthalmol. 2002;47(suppl 1):S203–18.

    Article  Google Scholar 

  8. Rossetti L, Autelitano A. Cystoid macular edema following cataract surgery. Curr Opin Ophthalmol. 2000;11:65–72.

    Article  CAS  Google Scholar 

  9. Ozdemir H, Karacorlu S, Karacorlu M. Postoperative subretinal fluid associated with cystoid macular edema following cataract surgery. Retina. 2005;25:223–5.

    Article  Google Scholar 

  10. Miyake K. Indomethacin in the treatment of postoperative cystoid macular edema. Surv Ophthalmol. 1984;28:554–68.

    Article  Google Scholar 

  11. Ahuja M, Dhake AS, Sharma SK, Majumdar DK. Topical ocular delivery of NSAIDs. AAPS J. 2008;10:229–41.

    Article  CAS  Google Scholar 

  12. Miyake K. Nonsteroidal anti-inflammatory agents in cataract intraocular lens surgery [editorial review]. Curr Opin Ophthalmol. 1995;6(1):62–5.

    CAS  PubMed  Google Scholar 

  13. Ylinen P, Taipale C, Lindholm JM, Laine I, Holmström E, Tuuminen R. Postoperative management in cataract surgery: nepafenac and preservative-free diclofenac compared. Acta Ophthalmol. 2018;96(8):853–9.

    Article  CAS  Google Scholar 

  14. Stock RA, Galvan DK, Godoy R, Bonamigo EL. Comparison of macular thickness by optical coherence tomography measurements after uneventful phacoemulsification using ketorolac tromethamine, nepafenac, versus a control group, preoperatively and postoperatively. Clin Ophthalmol. 2018;12:607–11.

    Article  CAS  Google Scholar 

  15. 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. 2017;255:639–49.

    Article  CAS  Google Scholar 

  16. •• Juthani VV, Clearfield E, Chuck RS. Nonsteroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database Syst Rev. 2017;7:CD010516 This Cochrane review of 48 randomized control trials examining NSAID and corticosteroid monotherapy and combination therapy for prevention of PCME suggested that the combination of NSAID and corticosteroid may be superior to monotherapy alone.

    PubMed  Google Scholar 

  17. Zhao X, Xia S, Wang E, Chen Y. Comparison of the efficacy and patients’ tolerability of nepafenac and ketorolac in the treatment of ocular inflammation following cataract surgery: a meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0173254.

    Article  Google Scholar 

  18. Campa C, Salsini G, Perri P. Comparison of the efficacy of dexamethasone, nepafenac, and bromfenac for preventing pseudophakic cystoid macular edema: an open-label, prospective, randomized controlled trial. Curr Eye Res. 2018;43(3):362–7.

    Article  CAS  Google Scholar 

  19. Chinchurreta Capote AM, Lorenzo Soto M, Rivas Ruiz F, Caso Peláez E, García Vázquez A, Group OftaCosta, et al. Comparative study of the efficacy and safety of bromfenac, nepafenac and diclofenac sodium for the prevention of cystoid macular edema after phacoemulsification. Int J Ophthalmol. 2018;11(7):1210–6.

    PubMed  PubMed Central  Google Scholar 

  20. •• Modjtahedi BS, Paschal JF, Batech M, et al. Perioperative topical nonsteroidal anti-inflammatory drugs for macular edema prophylaxis following cataract surgery. Am J Ophthalmol. 2017;176:174–82 This large, retrospective review of 89 731 cataract surgery patients showed a trend towards less PCME in patients receiving combination corticosteroid and NSAID therapy versus monotherapy; however, it did not reach statistical significance. The study determined a number needed to treat of 320 to prevent 1 case of PCME, suggesting the use of NSAIDs, particularly in low-risk patients, may not be cost-effective.

    Article  CAS  Google Scholar 

  21. Katsev DA, Katsev CC, Pinnow J, Lockhart CM. Intracameral ketorolac concentration at the beginning and end of cataract surgery following pre-operative topical ketorolac administration. Clin Ophthalmol. 2017;11:1897–901.

    Article  CAS  Google Scholar 

  22. Almeida D, Khan Z, Xing L, Bakar S, Rahim K, Urton T, et al. Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoemulsification. J Cataract Refract Surg. 2012;38:1537–43.

    Article  Google Scholar 

  23. Almeida D, Johnson D, Hollands H, Smallman D, Baxter S, Eng K, et al. Effect of prophylactic nonsteroidal anti-inflammatory drugs on cystoid macular edema assessed using optical coherence tomography quantification of total macular volume after cataract surgery. J Cataract Refract Surg. 2008;34:64–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Queen’s University, Kingston, Ontario, Canada

    Todd Urton & Jessica Ruzicki

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  1. Todd Urton
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  2. Jessica Ruzicki
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Correspondence to Todd Urton.

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Urton, T., Ruzicki, J. Review of the Evidence for Topical Nonsteroidal Anti-inflammatory Drugs Post-cataract Surgery. Curr Ophthalmol Rep 7, 219–223 (2019). https://doi.org/10.1007/s40135-019-00221-0

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  • DOI: https://doi.org/10.1007/s40135-019-00221-0

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