NSAID monotherapy may be best choice to prevent CME after cataract surgery
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Combination corticosteroid and NSAID eye drops are not superior to NSAID monotherapy as a prophylaxis for cystoid macular edema after cataract surgery.
Study results also showed no difference between the regimens when treatment was initiated 3 days before surgery or on the day of surgery.
Five different anti-inflammatory prophylactic regimens were compared in 470 patients undergoing cataract surgery. They were randomly assigned to receive a combination of corticosteroid (prednisolone 1%) and NSAID (ketorolac tromethamine 0.5%) drops initiated 3 days before surgery or on the day of surgery, NSAID eye drop monotherapy initiated 3 days before surgery or on the day of surgery, or a sub-Tenon’s depot of dexamethasone administered at the end of surgery. In all five groups, the treatment was continued until 3 weeks after surgery.
At 3 months, mean central subfield thickness (CST) was 250.7 µm in both prednisolone plus NSAID groups. In the NSAID monotherapy group, CST was 251.3 µm with initiation 3 days before surgery and 249.2 µm with initiation on the day of surgery. In the sub-Tenon’s group, mean CST was 255.2 µm, but more than half of the participants required additional topical anti-inflammatory treatment. No difference was found in visual acuity measurements, but IOP was higher in the groups in which corticosteroids were used.
The authors said that this outcome confirms what was found in other randomized trials showing no significant added benefit in adding topical corticosteroids to topical NSAIDs to prevent inflammatory complications of cataract surgery.
In addition, “intraocular pressure was higher in groups that used prednisolone eye drops compared with NSAID monotherapy and sub-Tenon dexamethasone depot in the first 3 weeks postoperatively. Therefore, NSAID monotherapy with initiation on the day of surgery may be preferred as an anti-inflammatory prophylactic regimen in uncomplicated cataract surgery,” they wrote.
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