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NSAID Eye Drops May Suffice for Cataract Surgery Prophylaxis

Initiation of prophylactic treatment three days before surgery is not superior to initiation on day of surgery

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FRIDAY, Aug. 13, 2021 (HealthDay News) -- For patients undergoing uncomplicated cataract surgery, a combination of prednisolone and nonsteroidal anti-inflammatory drug (NSAID) eye drops is not superior to NSAID monotherapy, and initiating prophylactic treatment three days before surgery is no better than on the day of surgery, according to a study published online Aug. 12 in JAMA Ophthalmology.

Jesper Høiberg Erichsen, M.D., Ph.D., from Rigshospitalet Glostrup in Denmark, and colleagues conducted a randomized clinical trial involving low-risk patients undergoing phacoemulsification for age-related cataract by an experienced surgeon. A total of 470 participants were randomly assigned to one of five anti-inflammatory prophylactic regimens: eye drops with a combination of prednisolone and ketorolac tromethamine, with or without preoperative initiation (preoperative prednisolone plus NSAID [control] and postoperative prednisolone plus NSAID groups); ketorolac monotherapy with or without preoperative initiation (preoperative and postoperative NSAID groups); or sub-Tenon depot of dexamethasone phosphate (sub-Tenon group).

The researchers found that mean central subfield thickness (CST) was 250.7 μm in the control group, 250.7 μm in the postoperative prednisolone plus NSAID group, 251.3 μm in the preoperative NSAID group, 249.2 μm in the postoperative NSAID group, and 255.2 μm in the sub-Tenon group at three months after surgery. Compared with control, there were no significant differences observed in CST or visual acuity and no differences seen between the preoperative and postoperative groups. In the sub-Tenon group, 56.6 percent needed additional anti-inflammatory treatment.

"NSAID monotherapy with initiation on the day of surgery may be preferred as an anti-inflammatory prophylactic regimen in uncomplicated cataract surgery," the authors write.

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