Anti‐inflammatory medication following cataract surgery: a randomized trial between preservative‐free dexamethasone, diclofenac and their combination

Ylinen, Pekka; Holmström, E.; Laine, Ilkka; Lindholm, Juha Matti; Tuuminen, Raimo

doi:10.1111/aos.13670

Cited by 31 publications

(42 citation statements)

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“…Incidence of drug-related symptoms in the study was relatively high compared to clinical experience, but comparable to the findings of our previous report on topical NSAID medication (Ylinen et al 2018). In fact, preservative-free diclofenac has been the primary antiinflammatory drug in our unit, used for approximately 2000 cataract surgeries per year.…”

Section: Discussionsupporting

confidence: 86%

“…Surprisingly, the study subjects had significantly fewer subjective irritation symptoms from using nepafenac, leading to the rejection of our hypothesis. Incidence of drug-related symptoms in the study was relatively high compared to clinical experience, but comparable to the findings of our previous report on topical NSAID medication (Ylinen et al 2018). When assessing these results, it should be noted that concomitant use of chronic eye drops might affect both the clinical efficacy and tolerability of the studied anti-inflammatory drugs.…”

Section: Discussionsupporting

confidence: 86%

“…Preference is shifting towards NSAIDs instead of steroids for treating postcataract removal inflammation (Kessel et al 2014;Wielders et al 2015;Ylinen et al 2018). The choice between various NSAIDs has not been backed by sufficient clinical experiments (Kessel et al 2014).…”

Section: Discussionmentioning

confidence: 99%

“…A standardized phacoemulsification technique was used for all cataract surgeries (hrrg.fi/en/videos/cataract/), as described in (Ylinen et al 2018). …”

Section: Surgerymentioning

confidence: 99%

“…Biometry [using swept-source optical coherence tomography (SSOCT) technology], aqueous flare (using automated laser flare metering technology), best corrected visual acuity (BCVA) and intraocular pressure (IOP) were evaluated as described in our earlier report (Ylinen et al 2018). The change in CRT was measured with SD-OCT (Heidelberg Engineering GmbH).…”

Section: Clinical Evaluationmentioning

confidence: 99%

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Postoperative management in cataract surgery: nepafenac and preservative‐free diclofenac compared

Ylinen

Taipale

Lindholm

et al. 2018

Acta Ophthalmologica

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Purpose: Current cataract surgery guidelines recommend routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing pseudophakic cystoid macular oedema (PCME). Here, we compare the clinical efficacy and tolerability of two potent NSAIDs, nepafenac and preservative-free diclofenac following cataract surgery. Methods: Randomized, double-blind, prospective single-centre study. Ninety-six eyes of 95 patients undergoing routine cataract surgery were randomized 1:1 either to nepafenac (Nevanac, 1 mg/ml) or diclofenac (Dicloabak, 1 mg/ml) for 3 weeks. Seventy-three patients accounting for 73 eyes completed the entire follow-up. Aqueous flare and central retinal thickness (CRT) analysis were conducted preoperatively and at control visits 28 days and 3 months after surgery. A structured home questionnaire and interview were used to record any adverse effects of the topical medications, subjective visual recovery and the dispenser's ease of use. Results: No differences were observed between the groups for aqueous flare, CRT, speed of recovery or visual acuity gain. Seven patients (16%) on nepafenac and 20 patients (48%) on preservative-free diclofenac reported symptoms related to topical use of NSAID medications (p = 0.001). Conclusion: No differences in clinical efficacy were found between potent NSAIDs, while tolerability might be an issue.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

“…A standardized phacoemulsification technique was used for all cataract surgeries (hrrg.fi/en/videos/cataract/), as described in (Ylinen et al 2018). …”

Section: Surgerymentioning

confidence: 99%

Section: Clinical Evaluationmentioning

confidence: 99%

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Postoperative management in cataract surgery: nepafenac and preservative‐free diclofenac compared

Ylinen

Taipale

Lindholm

et al. 2018

Acta Ophthalmologica

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Prednisolone and Ketorolac vs Ketorolac Monotherapy or Sub-Tenon Prophylaxis for Macular Thickening in Cataract Surgery

et al. 2021

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The choice of anti-inflammatory prophylaxis parallel to cataract surgery is important for patient safety and successful outcome of surgery, but which regimen to choose is contested.OBJECTIVES To determine whether a combination of prednisolone and nonsteroidal anti-inflammatory drug (NSAID) eye drops was superior in preventing increased central macular thickness (central subfield thickness [CST]) after uncomplicated cataract surgery compared with NSAID monotherapy and sub-Tenon capsule depot (dropless surgery), and to test whether preoperative initiation of eye drop treatment was superior to initiation on the day of surgery. DESIGN, SETTING, AND PARTICIPANTS This investigator-driven, single-center, randomized clinical trial with masked statistical analyses enrolled patients at the Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark, from February 1, 2018, to August 15, 2019. Follow-up was completed December 18, 2019. Participants included low-risk patients undergoing phacoemulsification for age-related cataract by an experienced surgeon (1 eye per participant). Data were analyzed from February 17 to June 15, 2020.INTERVENTIONS Participants scheduled for cataract removal were randomized to 1 of 5 anti-inflammatory prophylactic regimens: eye drops with a combination of prednisolone, 1%, and ketorolac tromethamine, 0.5%, with or without preoperative initiation (preoperative prednisolone plus NSAID [control] and postoperative prednisolone plus NSAID groups), ketorolac monotherapy with or without preoperative initiation (preoperative and postoperative NSAID groups), or sub-Tenon depot of dexamethasone phosphate (sub-Tenon group). Eye drops were administered 3 times per day until 3 weeks postoperatively. MAIN OUTCOMES AND MEASURES CST 3 months postoperatively.RESULTS A total of 470 participants (mean [SD] age, 72.2 [7.0] years; 290 women [61.7%]) with 94 participants in each group were included in the analysis. Three months after surgery, the mean CST was 250.7 (95% CI, 247.6-253.7) μm in the preoperative prednisolone plus NSAID group, 250.7 (95% CI, 247.8-253.7) μm in the postoperative prednisolone plus NSAID group, 251.3 (95% CI, 248.2-254.4) μm in the preoperative NSAID group, 249.2 (95% CI, 246.2-252.3) μm in the postoperative NSAID group, and 255.2 (95% CI, 252.0-258.3) μm in the sub-Tenon group. There were no significant differences in CST or visual acuity compared with control and no differences between preoperative and postoperative groups, but 47 of 83 participants (56.6%) in the sub-Tenon group needed additional anti-inflammatory treatment.CONCLUSIONS AND RELEVANCE No differences in CST or visual acuity were detected between the combination of prednisolone and NSAID eye drops vs NSAID monotherapy or sub-Tenon dexamethasone depot, although more than one-half of patients in the sub-Tenon arm received additional anti-inflammatory treatment. Initiating prophylaxis 3 days preoperatively was not superior to initiation on the day of surgery. Monotherapy with NSAIDs may be preferred in uncomplicate...

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Early Inflammation Control After Trabeculectomy by Steroid and Non-steroidal Eye Drops: A Randomized Controlled Trial

et al. 2023

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Introduction:To compare the effect of three different anti-inflammatory regimens consisting of preservative-free dexamethasone (DEX), diclofenac (DICLO) eye drops, and their combination (DEX ? DICLO) following trabeculectomy on early postoperative inflammation. Methods: A prospective randomized controlled trial. Sixty-nine patients undergoing trabeculectomy were randomized to receive either postoperative treatment with topical DEX (n = 23), topical DICLO (n = 23), or a combination of topical DEX and topical DICLO (n = 23) after trabeculectomy. The primary outcome was the anterior chamber flare measurement in the first 3 months postoperatively. Secondary outcomes included intraocular pressure, central corneal thickness, conjunctival injection, and number of cells in the anterior chamber from baseline to 3 months postoperatively.Results: Anterior chamber flare reached a maximum 1 day after trabeculectomy with an increase of 55% (95% CI 37-73%) for DEX, 64% (95% CI 47-82%) for DICLO, and 57% (95% CI 39-75%) for DEX ? DICLO and returned to near pre-operative values 6 weeks after surgery. There were no significant differences in anterior chamber flare [effect size for DICLO: 0.16 (95% CI -4.3 to 4.6), effect size for DEX ? DICLO: 0.09 (95% CI -4.1 to 4.3)], intraocular pressure, central corneal thickness, conjunctival injection, or number of cells in the anterior chamber between DEX, DICLO, or DEX ? DICLO groups. Conclusion: We found that topical diclofenac was not statistically different from topical dexamethasone in controlling early postoperative inflammation after trabeculectomy, while combining diclofenac and dexamethasone offered no added anti-inflammatory control compared to dexamethasone alone. Trial Registration: www.clinicaltrials.gov (NCT04054830).

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Anti‐inflammatory medication following cataract surgery: a randomized trial between preservative‐free dexamethasone, diclofenac and their combination

Abstract: Diclofenac (DICL), as well as the combination of DEX and DICL, were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME. Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.

Cited by 31 publications

References 31 publications

Postoperative management in cataract surgery: nepafenac and preservative‐free diclofenac compared

Postoperative management in cataract surgery: nepafenac and preservative‐free diclofenac compared

Prednisolone and Ketorolac vs Ketorolac Monotherapy or Sub-Tenon Prophylaxis for Macular Thickening in Cataract Surgery

Early Inflammation Control After Trabeculectomy by Steroid and Non-steroidal Eye Drops: A Randomized Controlled Trial

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