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.