Healio
Healio
January 11, 2016
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NSAIDs may inhibit prostaglandin release in femtosecond cataract surgery

Pretreatment with NSAIDs reduced prostaglandin release in patients undergoing femtosecond laser-assisted cataract surgery, according to a study.

“Therefore, it has potential to limit intraoperative laser-induced miosis,” the study authors said. “Previous studies detected elevated prostaglandin levels after femtosecond laser treatment and identified them as a potential mediator for laser-induced miosis.”

The prospective study included 75 patients who underwent image-guided femtosecond laser cataract surgery or conventional cataract surgery. Twenty patients underwent routine microincision cataract surgery (control group), 20 patients underwent routine microincision cataract surgery with a topical NSAID (control plus NSAID group), 18 patients underwent femtosecond laser cataract surgery (femtosecond laser group), and 17 patients underwent femtosecond laser cataract surgery with a topical NSAID (femtosecond laser plus NSAID group).

Prostaglandin levels obtained during surgery measured 294.4 pg/mL in the femtosecond laser group and 109.6 pg/mL in the control group; the between-group difference was statistically significant (P = .007).

NSAID pre-treatment reduced prostaglandin levels in both groups. The lowest prostaglandin concentrations were 63.9 pg/mL in the control plus NSAID group and 65.3 pg/mL in the femtosecond laser plus NSAID group.

The highest prostaglandin concentration was in the femtosecond laser group. Levels were significantly lower in the femtosecond laser plus NSAID group (P = .0009) and in the control group (P = .0007). – by Matt Hasson

Disclosure: Dick reports he is a consultant for Abbott Medical Optics. The other authors report no relevant financial disclosures.

Perspective

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John A. Hovanesian, MD, FACS
John A. Hovanesian, MD, FACS
This study adds to the body of knowledge that supports the use of preoperative NSAIDs. Prior studies of Eric Donnenfeld and others have shown increased inhibition of prostaglandins when NSAIDs are dosed for 3 days before surgery. There are two primary reasons to include NSAIDs in the preoperative regimen:  prevention of miosis and prevention of cystoid macular edema. It is additionally worth considering intraoperative use of NSAIDs in the infusion bottle, which is now available in the combination drug Omidria (phenylephrine 1.0%/ketorolac 0.3%, Omeros).  We have found the latter product to be particularly helpful in the prevention of intraoperative miosis, more so than preoperative NSAID drops that are flushed from the intraocular environment with the first infusion of surgical fluid.
John A. Hovanesian, MD, FACS
OSN Cataract Surgery Section Editor
Disclosures: Hovanesian reports he is a consultant for Alcon, Allergan, Bausch + Lomb and Omeros.
Sources/Disclosures

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Source:

Schultz T, et al. J Refract Surg. 2015;doi:10.3928/1081597X-20151111-01.