Combination Therapy Triumphs Over Steroids in Post-op Care of Cataract Surgery

In a comprehensive meta-analysis evaluating the safety and efficacy of postoperative management strategies for age-related cataracts in adults, researchers have uncovered compelling evidence that challenges conventional treatment practices. The study delved into the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and combination therapies in optimizing patient outcomes following cataract surgery and found that NSAIDs and combination treatments could be regarded as more effective and safer alternatives to corticosteroids alone in the postoperative management of cataract surgery.

The study results were published in the American Journal of Ophthalmology. 

The study, conducted using the rigorous PRISMA system and registered with PROSPERO (CRD42022364733), delved into the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and combination therapies in optimizing patient outcomes following cataract surgery. The meta-analysis incorporated data from nineteen studies, involving 3,473 patients (with 3,638 eyes) who underwent age-related cataract surgery. Among these patients, some were treated with NSAIDs (n=1,479), corticosteroids (n=1,307), or a combination of both (n=687).

Findings:

• A significant advantage was conferred by the combination therapy in terms of best-corrected visual acuity.
• When compared to corticosteroids alone, combination treatment demonstrated a favorable outcome at 4-6 weeks postoperatively, with a mean difference of -0.01 logMAR (95% CI: -0.02, -0.01) and no significant heterogeneity (I2=0%).
• Furthermore, NSAIDs exhibited superior outcomes in reducing flare values when compared to corticosteroids at various postoperative time points.
• On day 7, the mean difference was -9.17 photons/ms (95% CI: -16.52, -1.82), with an I2 of 94%.
• Similar trends were observed on day 14 (MD=-5.23 photons/ms, 95% CI: -8.35, -2.11, I2=94%) and at 4-6 weeks postoperatively (MD=-1.62 photons/ms, 95% CI: -3.03, -0.20, I2=93%).
• Notably, NSAIDs also demonstrated a significant advantage in terms of lower central macular thickness 4-8 weeks postoperatively, with a mean difference of -13.26 micrometers (95% CI: -18.66, -7.86, I2=81%), compared to corticosteroids.
• In addition to these visual outcomes, the study revealed that both NSAIDs and combination therapy experienced a lower incidence of central macular edema when compared to corticosteroids at 4-8 weeks postoperatively, with odds ratios of 0.16 (95% CI: 0.07, 0.35, I2=61%) and 0.21 (95% CI: 0.10, 0.45, I2=31%), respectively.

Thus, this groundbreaking meta-analysis suggests that NSAIDs and combination therapies may represent more effective and safer alternatives to corticosteroids alone for the postoperative management of cataract surgery. Despite these compelling findings, the study also highlights the need for further research to bridge the gap between evidence and clinical practice and to provide a more in-depth comparison of the effectiveness of NSAIDs and combination treatments in cataract surgery care.

Further reading: Haddad JE, Sabbakh NA, Macaron MM, et al. NSAIDs and corticosteroids for the postoperative management of age-related cataract surgery: a systematic review and meta-analysis [published online ahead of print, 2023 Oct 3]. Am J Ophthalmol. 2023;S0002-9394(23)00421-X. doi:10.1016/j.ajo.2023.09.027