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

American journal of ophthalmology, 2024-04, Vol.260, p.1-13 [Peer Reviewed Journal]

2023 Elsevier Inc. ;Copyright © 2023 Elsevier Inc. All rights reserved. ;ISSN: 0002-9394 ;EISSN: 1879-1891 ;DOI: 10.1016/j.ajo.2023.09.027 ;PMID: 37797866

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  • Title:
    NSAIDs and Corticosteroids for the Postoperative Management of Age-Related Cataract Surgery: A Systematic Review and Meta-analysis
  • Author: Haddad, Joe El ; Sabbakh, Nader Al ; Macaron, Marie Michele ; Shaaban, Hashim ; Bourdakos, Natalie E. ; Shi, Ao ; Saad, Baraa ; Nakanishi, Hayato ; Than, Christian A. ; Daoud, Yassine J.
  • Subjects: Adrenal Cortex Hormones - therapeutic use ; Adult ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Cataract - complications ; Cataract Extraction - adverse effects ; Humans ; Macular Edema - drug therapy ; Macular Edema - etiology
  • Is Part Of: American journal of ophthalmology, 2024-04, Vol.260, p.1-13
  • Description: 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. Meta-analysis. 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. 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. 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.
  • Publisher: United States: Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0002-9394
    EISSN: 1879-1891
    DOI: 10.1016/j.ajo.2023.09.027
    PMID: 37797866
  • Source: MEDLINE
    Alma/SFX Local Collection
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