Meta-analysis METHODS: Cochrane, Embase, PubMed, Scopus, Web of Science and CiNAHL were searched for articles using the
PRISMA system. The review was registered prospectively with PROSPERO (CRD42022364733). Randomized control trials of patients undergoing age-related
cataract surgery treated with
corticosteroids,
NSAIDs or a combination were included.
RESULTS: Nineteen studies were included, with 3,473 patients (Neyes=3,638) treated following
cataract surgery with
NSAIDs (n=1,479),
corticosteroids (n=1,307) or combination (n=687). Combination treatment demonstrated favorable best corrected visual acuity compared to
corticosteroids 4-6 weeks postoperatively (MD=-0.01 logMAR, 95% CI: -0.02, -0.01, I2=0%).
NSAIDs had more favorable flare values than
corticosteroids on day 7 (MD=-9.17 photons/ms, 95% CI: -16.52, -1.82, I2=94%), day 14 (MD=-5.23 photons/ms, 95% CI: -8.35, -2.11, I2=94%) and 4-6 weeks (MD=-1.62 photons/ms, 95% CI: -3.03, -0.20, I2=93%) postoperatively. Furthermore, 4-8 weeks postoperatively,
NSAIDs showed lower central macular thickness (MD=-13.26 micrometers, 95% CI: -18.66, -7.86, I2=81%) compared to
corticosteroids.
NSAIDs and combination experienced lower incidence of central
macular edema (OR=0.16, 95% CI: 0.07, 0.35, I2=61%) (OR=0.21, 95% CI: 0.10, 0.45, I2=31%) than
corticosteroids 4-8 weeks postoperatively.
CONCLUSIONS:
NSAIDs and combination treatments could be regarded as more effective and safer alternatives to
corticosteroids alone in the postoperative management of
cataract surgery. Further studies should be conducted as to why this evidence has not been reflected in practice patterns and to further compare the effectiveness of
NSAIDs and combination treatments.