A successful post-cataract surgery outcome hinges on the ability to control the inflammatory response. While steroids with broad anti-inflammatory effects are the traditional route, non-steroid anti-inflammatory drugs (NSAIDs) now show superiority in controlling post-op inflammation, according to a new study.

Researchers recently found no significant differences in anterior chamber flare between patients randomized to an NSAID or an NSAID with prednisolone—but a sub-Tenon's depot of dexamethasone was less efficient in controlling inflammation on its own.

This randomized, controlled trial evaluated 470 participants (62% were female) with a mean age of 72.2 years who were undergoing phacoemulsification for age-related cataract. They were randomized to one of five anti-inflammatory prophylactic regimens:

  • Groups a1 and a2: combination of topical prednisolone and ketorolac (NSAID)
  • Groups b1 and b2: ketorolac alone
  • Group c: dropless surgery (sub-tenon depot of dexamethasone)

The team initiated treatment three days before surgery in group 1 and on the day of surgery in group 2. They measured anterior chamber flare at baseline and three days after surgery.

The investigators observed a significant increase in flare from baseline in all groups, by 67.0%, 80.3%, 106.3%, 96.6% and 203.0% in groups a1, a2, b1, b2 and c, respectively. They note that the dropless group faced the most significant increase, with no significant differences between the other groups.

They administered additional anti-inflammatory treatment in less than 4% of participants in every group except for the dropless group (36.1%). They noted that visual acuity improved by -0.199logMAR with no significant differences between groups.

Erichsen JH, Holm L, Kessel L. Effect of anti-inflammatory regimen on early postoperative inflammation following cataract surgery. ARVO 2020. Abstract 813.