Topical NSAIDs not needed for uncomplicated cataract surgery

COS 2012, July 5 - Both ketorolac and nepafenac are well-tolerated medications with minimal side-effect profiles, but are not needed for patients who have uncomplicated cataract surgery and who don't have risk factors. In short, prophylactic use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) is not recommended.

These findings come from a randomized controlled trial comparing nepafenac, ketorolac and placebo, and how the drugs affected macular edema after routine cataract surgery. Results were presented by Dr. David Almeida, an ophthalmology resident at Queen's University, Kingston, Ont. The study won the COS Award for Excellence in Ophthalmic Research (2012).

The study was done, Almeida explained, because there are several issues around the use of topical NSAIDs in cataract surgery, including whether the drugs affect postoperative macular edema, superiority of one product over another, and questions of which patients would benefit most.

In the prospective placebo-controlled, double-blind trial, patients were given drops - either one of the topical NSAIDs or placebo - four times a day for one month starting one day before surgery. Health-related quality-of-life metrics were determined with the Comparison of Ophthalmic Medications for Tolerability (COMTOL) questionnaire. Optical coherence tomography (OCT) measures were performed before surgery and at one month after.

A total 162 patients were enrolled, with 54 randomly assigned to one of the four treatment groups. At one month, there was no statistically significant difference between groups for any of the OCT variables tested. Findings from the COMTOL questionnaire showed no significant differences in terms of frequency of side effects or limitations to activities due to side effects.

Previous research has indicated that, for cataract patients with risk factors or those who have complicated surgery, ketorolac is effective in decreasing macular edema, Almeida noted. But for patients whose surgery is not complicated and who have no risk factors, there are no benefits from using NSAIDs.