NSAIDs and Corticosteroids for the Postoperative Management of Age-Related Cataract Surgery: A Systematic Review and Meta-analysis

Joe El Haddad; Nader Al Sabbakh; Marie Michele Macaron; Hashim Shaaban; Natalie E Bourdakos; Ao Shi; Baraa Saad; Hayato Nakanishi; Christian A Than; Yassine J Daoud

doi:10.1016/j.ajo.2023.09.027

NSAIDs and Corticosteroids for the Postoperative Management of Age-Related Cataract Surgery: A Systematic Review and Meta-analysis

Am J Ophthalmol. 2024 Apr:260:1-13. doi: 10.1016/j.ajo.2023.09.027. Epub 2023 Oct 4.

Affiliations

¹ From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus.
² From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus; School of Biomedical Sciences (C.A.T.), The University of Queensland, St Lucia, Australia.
³ The Wilmer Eye Institute (Y.J.D.), The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. Electronic address: ydaoud1@jhmi.edu.

PMID: 37797866
DOI: 10.1016/j.ajo.2023.09.027

Abstract

Purpose: To evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in the postoperative management of cataract surgery for age-related cataract in adults.

Design: Meta-analysis.

Methods: Cochrane, Embase, PubMed, Scopus, Web of Science and CINAHL were searched for articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022364733). Randomized controlled trials of patients undergoing age-related cataract surgery treated with corticosteroids, NSAIDs, or a combination were included.

Results: A total of 19 studies were included, with 3473 patients (3638 eyes) treated following cataract surgery with NSAIDs (n = 1479), corticosteroids (n = 1307), or a combination (n = 687). Combination treatment demonstrated favorable best-corrected visual acuity compared to corticosteroids 4 to 6 weeks postoperatively (MD = -0.01 logMAR, 95% CI: -0.02, -0.01, I² = 0%). NSAIDs had more favorable flare values than corticosteroids on day 7 (MD = -9.17 photons/ms, 95% CI = -16.52, -1.82, I² = 94%), day 14 (MD = -5.23 photons/ms, 95% CI = -8.35, -2.11, I² = 94%), and 4 to 6 weeks (MD = -1.62 photons/ms, 95% CI = -3.03, -0.20, I² = 93%) postoperatively. Furthermore, 4 to 8 weeks postoperatively, patients treated with NSAIDs showed lower central macular thickness (MD = -13.26 µm, 95% CI = -18.66, -7.86, I² = 81%) compared to those treated with corticosteroids. NSAIDs and combination treatment were associated with a lower incidence of central macular edema (OR = 0.16, 95% CI = 0.07, 0.35, I² = 61%; OR = 0.21, 95% CI = 0.10, 0.45, I² = 31%) than corticosteroids 4 to 8 weeks postoperatively.

Conclusions: NSAIDs and combination treatments could be regarded as more effective and safer alternatives to corticosteroids alone in the postoperative management of cataract surgery. Further studies should be conducted to determine why this evidence has not been reflected in practice patterns, and to further compare the effectiveness of NSAIDs and combination treatments.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Adult
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Cataract Extraction* / adverse effects
Cataract* / complications
Humans
Macular Edema* / drug therapy
Macular Edema* / etiology

Substances

Anti-Inflammatory Agents, Non-Steroidal
Adrenal Cortex Hormones