Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark; Danish Health and Medicines Authority, Copenhagen, Denmark.
Danish Health and Medicines Authority, Copenhagen, Denmark.
Ophthalmology. 2014 Oct;121(10):1915-24. doi: 10.1016/j.ophtha.2014.04.035. Epub 2014 Jun 14.
Favorable outcome after cataract surgery depends on proper control of the inflammatory response induced by cataract surgery. Pseudophakic cystoid macular edema is an important cause of visual decline after uncomplicated cataract surgery.
We compared the efficacy of topical steroids with topical nonsteroidal anti-inflammatory drugs (NSAIDs) in controlling inflammation and preventing pseudophakic cystoid macular edema (PCME) after uncomplicated cataract surgery.
Patients undergoing uncomplicated surgery for age-related cataract.
We performed a systematic literature search in Medline, CINAHL, Cochrane, and EMBASE databases to identify randomized trials published from 1996 onward comparing topical steroids with topical NSAIDs in controlling inflammation and preventing PCME in patients undergoing phacoemulsification with posterior chamber intraocular lens implantation for age-related cataract.
Postoperative inflammation and pseudophakic cystoid macular edema.
Fifteen randomized trials were identified. Postoperative inflammation was less in patients randomized to NSAIDs. The prevalence of PCME was significantly higher in the steroid group than in the NSAID group: 3.8% versus 25.3% of patients, risk ratio 5.35 (95% confidence interval, 2.94-9.76). There was no statistically significant difference in the number of adverse events in the 2 treatment groups.
We found low to moderate quality of evidence that topical NSAIDs are more effective in controlling postoperative inflammation after cataract surgery. We found high-quality evidence that topical NSAIDs are more effective than topical steroids in preventing PCME. The use of topical NSAIDs was not associated with an increased events. We recommend using topical NSAIDs to prevent inflammation and PCME after routine cataract surgery.
白内障手术后的良好结果取决于对白内障手术引起的炎症反应的适当控制。后发性白内障是单纯性白内障手术后视力下降的重要原因。
我们比较了局部皮质类固醇与局部非甾体抗炎药（NSAIDs）在控制单纯性白内障手术后炎症和预防后发性白内障（PCME）方面的疗效。
接受单纯性白内障手术的年龄相关性白内障患者。
我们在 Medline、CINAHL、Cochrane 和 EMBASE 数据库中进行了系统文献检索，以确定 1996 年以来发表的比较局部皮质类固醇与局部 NSAIDs 在控制单纯超声乳化白内障吸除联合后房型人工晶状体植入术后炎症和预防年龄相关性白内障患者 PCME 的随机试验。
术后炎症和后发性白内障。
确定了 15 项随机试验。随机分配到 NSAIDs 的患者术后炎症较轻。皮质类固醇组的 PCME 发生率明显高于 NSAID 组：3.8%对 25.3%的患者，风险比 5.35（95%置信区间，2.94-9.76）。两组不良事件的数量无统计学差异。
我们发现，低至中等质量的证据表明，局部 NSAIDs 在控制白内障手术后的术后炎症方面更有效。我们发现高质量的证据表明，局部 NSAIDs 在预防 PCME 方面比局部皮质类固醇更有效。局部 NSAIDs 的使用与事件增加无关。我们建议在常规白内障手术后使用局部 NSAIDs 预防炎症和 PCME。
