Treating patients post-cataract surgery with NSAID eye drops, not combined with anything else, may promote an anti-inflammatory response. Photo: Oliver Kuhn-Wilken, OD.

Choosing the most effective anti-inflammatory prophylaxis after cataract surgery is important in ensuring successful outcomes, but which type of drugs are the most effective?

In a recent study of 470 patients, researchers sought to determine whether a combination of prednisolone and NSAID eye drops is better in preventing macular thickening after cataract surgery compared with NSAID monotherapy and dropless surgery using a sub-Tenon capsule depot. They also wanted to test whether pre-op eye drops are better than starting treatment the day of surgery.

Three months after surgery, no differences in central subfield thickness (CST) or visual acuity were detected between combination treatment of prednisolone and NSAID eye drops vs. NSAID monotherapy or sub-Tenon dropless surgery. More than half of the patients in the sub-Tenon group received additional anti-inflammatory treatment, which might explain why no difference in CST was found at three months, despite the significant increase in the measurement detected three weeks postoperatively.

Additionally, IOP was higher in the groups that used prednisolone eye drops compared with NSAID monotherapy and sub-Tenon dexamethasone depot in the first three weeks post-op. However, the mean IOP was low in all groups, and it didn’t rise above 25mm Hg at any post-op visit.

The main argument for not recommending NSAIDs has been the lack of success compared with prednisolone drops, which “are theoretically more efficient than more potent corticosteroids owing to a greater intraocular bioavailability,” the team noted. Because of this, they chose prednisolone for the combination group.

“We found that a combination of prednisolone and NSAID eye drops was not superior to NSAID monotherapy and that initiating prophylactic treatment three days before surgery was not superior to initiating treatment on the day of surgery in preventing thickening of the central subfield after uncomplicated cataract surgery,” the investigators concluded. “Therefore, NSAID monotherapy with initiation on the day of surgery may be preferred as an anti-inflammatory prophylactic regimen in uncomplicated cataract surgery.”

Erichsen JH, Holm LM, Jacobsen MF, et al. Prednisolone and ketorolac vs. ketorolac monotherapy or sub-tenon prophylaxis for macular thickening in cataract surgery a randomized clinical trial. JAMA Ophthalmol. August 12, 2021. [Epub ahead of print].