The comparative efficacy and safety of topical non-steroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis.

Abstract

PURPOSE:

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of anti-inflammatory drugs that are used in ophthalmologic surgery. These drugs do not have a steroid structure, but can inhibit surgery-induced miosis, anterior chamber inflammation, and cystoid macular edema (CME). However, the application of NSAIDs remains controversial. Therefore, we performed a meta-analysis to assess the efficacy and safety of NSAIDs for the treatment of anterior chamber inflammation after cataract surgery.

METHODS:

Relevant articles were identified from the PubMed, Embase, and Cochrane databases up to October 2016. The therapeutic effect of NSAIDs on anterior chamber inflammation was evaluated. The important outcomes of overall anterior chamber inflammation, freedom from ocular pain, and treatment-related/serious ocular adverse events were analyzed by using a random-effects network meta-analysis. The quality of evidence was assessed via the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach.

RESULTS:

A total of 19 trials assessing 7,234 patients were included in our meta-analysis. Diclofenac was the most likely to improve anterior chamber inflammation after cataract surgery, followed by nepafenac, ketorolac, bromfenac, and flurbiprofen. Nepafenac was most likely to improve postoperative ocular pain relief, followed by bromfenac and ketorolac. Our analysis of treatment-related/serious ocular adverse events revealed that piroxicam was most likely to have the fewest related adverse events, but the robustness of this finding was low. Diclofenac was another near-ideal drug, followed by nepafenac, bromfenac, and ketorolac.

CONCLUSIONS:

NSAIDs are effective drugs compared to placebos for the relief of anterior chamber inflammation. Furthermore, diclofenac, nepafenac, ketorolac, and bromfenac demonstrated relatively greater significant effects than those of other NSAIDs.

• Authors: Ping Duan, Yong Liu, Jiawen Li
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 255 Issue 4 Pg. 639-649 (Apr 2017) ISSN: 1435-702X [Electronic] Germany
• PMID: 28130595 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal

Topics

• Administration, Topical
• Anterior Chamber (pathology)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Cataract Extraction (adverse effects)
• Endophthalmitis (drug therapy, etiology)
• Humans
• Surgical Wound Infection (diagnosis)
• Treatment Outcome