NSAIDs and corticosteroids for the postoperative management of age-related cataract surgery: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs and corticosteroids in the postoperative management of cataract surgery for age-related cataract in adults. DESIGN: 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.