Eyeworld

JULY 2021 | EYEWORLD | 15 References 1. Kessel L, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology. 2014;121:1915– 1924. 2. Wielders LH, et al. Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: A system- atic review and meta-analysis. Am J Ophthalmol. 2015;160:968– 981. 3. Lim BX, et al. Prophylactic non-steroidal anti-inflamma- tory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database Syst Rev. 2016;11:CD006683. 4. Juthani VV, et al. Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling in- flammation after uncomplicated cataract surgery. Cochrane Da- tabase Syst Rev. 2017;7:CD010516. 5. Wielders LHP, et al. Euro- pean multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. J Cataract Refract Surg. 2018;44:429–439. 6. Lam DL, et al. A Rayleigh scat- ter-based ocular flare analysis meter for flare photometry of the anterior chamber. Transl Vis Sci Technol. 2015;4:7. 7. Jabs DA, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509– 516. pre-treating before surgery. NSAID monother- apy adequately controlled early postoperative inflammation. This group had a greater de- crease in intraocular pressure following cataract surgery when compared to the groups receiving prednisolone acetate. Dropless cataract surgery with subtenon dexamethasone did not control postoperative inflammation well. There were several limitations to this study. The authors excluded patients with ocular comorbidities, which limits generalizability. While a lesser reduction of IOP was found in groups receiving topical steroids, the clinical significance of this difference is unclear. The most significant limitation was the short follow- up period. During the ASCRS Journal Club discussion, members of the panel mentioned that the study only covered acute postoperative inflammation. Previous studies highlighting the benefits of NSAIDs following cataract surgery cited the decreased incidence of cystoid macular edema (CME) in the weeks following surgery. 2,5 This important benefit from NSAID treatment was not captured in this study. Previous studies show a benefit in combination therapy. 5 While Summary of results There were 438 participants providing data for the primary analysis. There was no statistically significant difference among the five treatment groups in CDE, with a median of 7.7 from all cases. AC inflammation as measured by the laser flare photometer increased in all five groups. Flare increased by 74.0% in the Pred+NSAID- Pre group, 78.8% in the Pred-NSAID-Post group, 103.7% in the NSAID-Pre group, 94.5% in the NSAID-Post group, and 201.3% in the Drop- less surgery group. The 201.3% increase in the Dropless group compared to the Pred+ NSAID- Pre control group was the only statistically significant increase among the five groups. After surgery, visual acuity improved in all five groups, and intraocular pressure decreased in all the groups. From a mean of 14.3 mm Hg, IOP decreased to 13.6 in the Pred+NSAID-Pre group, 13.4 in the Pred+NSAID-Post group, 11.5 in the NSAID-Pre group, 11.0 in the NSAID-Post group, and 10.3 in the Dropless group. Those groups that included prednisolone acetate had a lesser decrease in IOP on postop day 3 compared to those that did not include topical steroids. The authors found this to be a statistically significant difference. The study reported adverse events oc- curring in 89 (20.1%) of all participants. The Dropless group included 44 of the participants experiencing an adverse event. Of these, pain/ soreness and insufficiently controlled inflam- mation were most common. The authors found this disproportionate level of adverse events in the Dropless group to be statistically significant. More than a third of the patients in the Dropless groups had an anti-inflammatory drop added to their treatment on postop day 3. Discussion The authors concluded that monotherapy with NSAIDs may be the preferred prophylactic anti-inflammatory regimen after uneventful cataract surgery, with no added benefit of continued on page 16 "The authors concluded that monotherapy with NSAIDs may be the preferred prophylactic anti-inflammatory regimen after uneventful cataract surgery, with no added benefit of pre-treating before surgery."

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