JAMA Study: NSAID monotherapy can be a preventive alterenati
A Study was conducted 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, and to test whether preoperative initiation of eye drop treatment was superior to initiation on the day of surgery.

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, ketorolac monotherapy with or without preoperative initiation, or sub-Tenon depot of dexamethasone phosphate.

--A total of 470 participants with 94 participants in each group were included in the analysis. 3 months after surgery, the mean CST was 250.7 microm in the preoperative prednisolone plus NSAID group, 250.7 microm in the postoperative prednisolone plus NSAID group, 251.3 microm in the preoperative NSAID group, 249.2 microm in the postoperative NSAID group, and 255.2 microm 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 in the sub-Tenon group needed additional anti-inflammatory treatment.

Although more than half of patients in the sub-Tenon arm got additional anti-inflammatory treatment, no changes in CST or visual acuity were found between the combination of prednisolone and NSAID eye drops vs NSAID monotherapy or sub-Tenon dexamethasone depot. Prophylaxis started three days before surgery was not superior to prophylaxis started on the day of operation.

Source: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2782731