TABLE 3. The Effects of Nonsteroidal Anti-Inflammatory Drugs on Postoperative Inflammation: Randomized, Double-Masked, Placebo-Controlled Studies

Authors (no. of eyes) NSAID Surgery (no. of surgeons) Drug dosage Cells Flare Ciliary flush Results Fluorophotometry Comments
Conjunctival vasodilation Lid edema
Sabiston, et al188 (72) 0.03% Flurbiprofen solution (aqueous) ICCE (4) 1 gtt q.i.d. 3 days before surgery or 1 gtt 3 hr before surgery, then 1 gtt every 30 min to surgery p = 0.02 p = 0.02 ND p = 0.001 ND ND Statistical significance only on day 14 postoperative
Diestelhorst et al189 (20) 0.03% Flurbiprofen solution (aqueous) Phaco IOL (1) 6 gtt before surgery, then 1 gtt six times daily after surgery N.D. “Less” ND ND ND p < 0.001 One subject eliminated from each treatment group.
Blaydes et al190 (233) 0.03% Flurbiprofen solution (aqueous) Phaco IOL (1) 6 gtt before surgery, then 1 gtt six times daily after surgery p = 0.004 p = 0.002 ND p = 0.010 p = 0.033 p = 0.001 Photophobia (p = 0.001)Burning (p = 0.003)Irritation (p = 0.05)Corneal edema (p = 0.005)
Flach et al91 (100) 0. 5% Ketorolac tromethamine solution (aqueous) ECCE (1) 1 gtt t.i.d. beginning 1 day before surgery p = 0.043 N.D. p < 0.001 p < 0.001 p < 0.001 p < 0.001 No corticosteroids (paired comparison study)
Flach et al184 (129) 0. 5% Ketorolac tromethamine solution (aqueous) ECCE IOL (8) 1 gtt t.i.d. beginning 1 day before surgery p = 0.07* N.D. p = 0.002* p = 0.06* p = 0.001* p = 0.02* Need for steroids in placebo control greater than drug treatment group p < 0.001
Solomon et al185 (104) 0.5% Ketorolac tromethamine (aqueous) Phaco IOL (7) 1 gtt q.i.d. beginning 24 hours after surgery p = 0.002 p = 0.009 p = 0.022 p = 0.010 ND ND Subjects required having +2 to +4 cells/flare for entry.Vision improved.
Heier et al186 (102) 0.5% Ketorolac tromethamine (aqueous) Phaco IOL (6) 1 gtt q.i.d. beginning 24 hours after surgery p = 0.03 p = 0.025 p = 0.006 p = 0.046 ND ND Photophobia (p = 0.014)Pain (p = 0.049)Patient drop out (p = 0.005)
Kraff et al179 (148) 0.1% Diclofenac solution ECCE or Phaco IOL (1) 1 gtt q.i.d. beginning 22 to 34 hours after surgery p = 0.05 (Cells + flare) p = 0.05 (Cells + flare) p = 0.01 p = 0.01 ND ND Subjects required having +4-sum cells/flare for entry.Vision improved.
Vickers et al181 (309) 0.1% Diclofenac solution ECCE IOL (9) 1 gtt q.i.d. beginning 1 day after surgery   Mean inflammation score ∼ cells and flare p < 0.05         Unpublished as of December 2004
Mochizuki et al9 (69) 0.5% Indomethacin solution (oil) ICCE (4) 1 gtt 3, 2, 1 & 1/2 hr before surgery p < 0.05 p < 0.05 ND ND ND ND Use of corticosteroids in both treatment groups
Sanders, Kraff94 (283) 1% Indomethacin suspension (aqueous) ECCE IOL (1) 10 gtt over 18 hr before surgery, then 1 gtt q.i.d. Acceptable inflammation p < 0.05 vs. unacceptable +     p < 0.05 Use of corticosteroids in both treatments


*Results favor drug treatment despite statistically significant greater use of corticosteroids in placebo control.
†“Unacceptable” implies the surgeon would have changed the topical anti-inflammatory regimen based on evaluation of conjunctival injection, ciliary flush, aqueous cells, aqueous flare, and appearance of the cornea.
ND, not done; ICCE, intracapsular cataract surgery; ECCE, extracapsular cataract surgery; Phaco, phacoemulsification; IOL, intraocular lens.