Prophylactic postoperative ketorolac improves outcomes in diabetic patients assigned for cataract surgery

Abstract

ObjectiveTo evaluate the prophylactic role of topical non-steroidal anti-inflammatory drugs in reducing the incidence of central macular edema (CME) in diabetic eyes post-cataract surgery.Patients and methodsThis study included 86 eyes (70 patients) with high risk characteristics for the development of CME after cataract surgery. All patients underwent phacoemulsification and intraocular lens implantation. Patients were divided into two equal groups (n = 43 [eyes]): a control group given topical dexamethasone 0.1%, four times/day for 12 weeks postoperatively and a study group given topical ketorolac tromethamine 0.4% twice daily in addition to topical dexamethasone 0.1% four times daily for 12 weeks. Patients were examined at 3, 6, and 12 weeks postoperatively for evaluation of CME development. The main study outcome was the change in the retinal fovea thickness measured with ocular coherence topography.ResultsTen eyes developed CME (11.6%); eight eyes in the control group and only two eyes in the study group. Mean retinal fovea thickness was significantly higher in the control group compared to the study group. Moreover, eyes of the control group developed CME significantly earlier than those of the study group.ConclusionProphylactic postoperative ketorolac 0.4% may have a role in reducing the frequency and severity of CME in diabetic eyes post-cataract surgery.

Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery

“…Some studies included a group of participants who received other types of cataract surgery, in which case we used only the data from the participants who underwent phacoemulsification. The studies were conducted in 17 different countries: three in Brazil (Ticly 2014; Tzelikis 2015; Zanetti 2012), two in Canada (Almeida 2008; Almeida 2012), four in China (Chen 2015; Li 2011; Wang 2013; Zhang 2008), one in Cuba (Ruiz Rodríguez 2011), one in Egypt (Elsawy 2013), one in France (Adam 2005), two in Germany (Hessemer 1996; Schmitt 1995), two in Greece (Chatziralli 2011; Moschos 2012), one in India (Sahu 2015), one in Iran (Entezari 2016), seven in Japan (Asano 2008; Endo 2010; Kato 1998; Miyake 2007; Miyake 2011; Miyanaga 2009; Shimazaki 1996), one in Mexico (Cervantes-Coste 2009), one in South Korea (Jung 2015), two in Sweden (Laurell 2002; Zaczek 2014), one in Thailand (Trinavarat 2003), two in Turkey (Dal 2014; Yavas 2007), and seven in the United States (Duong 2014; el-Harazi 1998; Holzer 2002; Mathys 2010; Singh 2012; Solomon 2001; Wittpenn 2008). Investigators of nine studies did not report in which country the trial had been conducted (Bucci 2001; Demco 1997; Donnenfeld 2006; Guzey 2000; McColgin 1999; Mulet 2001; Ostrov 1997; Roberts 1995; Voudouri 2002).…”

“…Nineteen studies compared a combination of an NSAID plus a corticosteroid with a corticosteroid only (Adam 2005; Almeida 2008; Cervantes-Coste 2009; Chatziralli 2011; Chen 2015; Dal 2014; Elsawy 2013; Entezari 2016; Li 2011; Mathys 2010; McColgin 1999; Moschos 2012; Ruiz Rodríguez 2011; Shimazaki 1996; Singh 2012; Ticly 2014; Wittpenn 2008; Zaczek 2014; Zhang 2008). Fourteen other studies had three or more arms and had such combinations as an NSAID alone versus a corticosteroid alone versus a combination (Hessemer 1996; Miyanaga 2009; Schmitt 1995); multiple NSAIDs compared with each other and versus a corticosteroid (el-Harazi 1998; Mulet 2001; Zanetti 2012); an NSAID versus a corticosteroid versus a different corticosteroid (Ostrov 1997; Trinavarat 2003); and multiple combinations of an NSAID plus a corticosteroid against each other with a corticosteroid-only arm in addition (Almeida 2012; Donnenfeld 2006; Jung 2015; Sahu 2015; Tzelikis 2015; Yavas 2007).…”

Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

“…Studies comparing combination of Nepafenac and Dexamethasone with Dexamethasone alone in prevention of ME and change in macular volume after cataract surgery have shown clear benefit of use of combination 5. Another study comparing combination of Ketorolac and Dexamethasone with Dexamethasone alone have shown four times more patients developing ME in Dexamethasone alone group 22. Therefore, there is sufficient evidence advocating use of topical nepafenac in adjunction with topical steroids for prevention of ME in patients with NPDR.…”

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

“…The sample size is probably too small to find out any adverse effects such as endophthalmitis, retinal detachment, and vitreous hemorrhage. It deals with an important problem and one that can be frustrating for the cataract surgeon who might feel robbed of success after a perfectly executed cataract (mm Hg) 14.4 ± 4.32 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 16.4 ± 4.4 14.8 ± 5 13.54 ± 4.2 P = 0.56 P = 0.48 P = 0.6…”

“…8,9 In cases that do not resolve spontaneously, a course of topical steroids and non-steroidal anti-inflammatory agents (NSAIDS) helps in the resolution of a large proportion of cases. 10 A certain subset of patients, however, does not respond to topical therapy alone. A step ladder approach for the management of these patients is proposed and includes oral carbonic anhydrase inhibitor therapy, 11 peribulbar 12 or intravitreal steroids, 13 anti-VEGF agents, 14 immunomodulators 15,16 and, in cases secondary to vitreous traction, Nd: Yag laser vitreolysis, 17 vitrectomy, 18 or other surgical approaches.…”