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Surgeon: NSAID use should be "routine now" in cataract surgery
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KOLOA, Hawaii — Now that four safe and effective non-steroidal anti-inflammatory drugs are available to enhance surgical outcomes, their use should be standard of care among cataract surgeons, according to one presenter here.
Speaking at Subspecialty Saturday preceding Hawaiian Eye 2007, Michael B. Raizman, MD, said that NSAIDs should be used for four main indications: reduction of postoperative cell and flare, prevention and treatment of cystoid macular edema (CME), maintenance of pupil dilation during surgery, and the control of pain during and after surgery.
The four NSAIDs Dr. Raizman referred to are Voltaren (diclofenac, Novartis), Acular LS (ketorolac tromethamine 0.4%, Allergan), Nevanac (nepafenac sodium, Alcon) and Xibrom (bromfenac, ISTA Pharmaceuticals).
In the absence of strong head-to-head data comparing the available NSAIDs for all four of these indications, surgeons will have to rely largely on their own clinical experience to determine which to use.
"For now we can feel comfortable using any of these agents," Dr. Raizman said. "I would stress that the important thing is to use them. It's not so much about which you should use, but that they should be used."
He added that the duration of use should be extended in patients with a higher risk of developing CME, including those with diabetes, uveitis, pupil manipulation during surgery, vitreous loss, CME in the other eye, retinal vascular disease or epiretinal membrane.
In these patients he starts NSAID use up to 1 week before surgery, rather than the typical 2 to 3 days, and continues them for 6 weeks or longer postoperatively.