Topical nonsteroidal anti-inflammatory drugs in the prevention of pseudophakic cystoid macular edema following phacoemulsification: A systematic review

Abstract

Introduction: The goal of surgeons to avoid Pseudophakic Cystoid Macular Edema (PCMO) has led to the widespread use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) after cataract surgery, although current research into the best anti-inflammatory drugs to avoid PCMO is still underway. This review aimed to determine the efficacy of topical NSAIDs in preventing PCMO following phacoemulsification. Methods: This systematic review was built on the recommended reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for papers during the previous 10 years. The keywords was searched by Boolean operator: “NSAIDs” AND “Prevention” AND “Cystoid Macular Edema” AND “Optical Coherence Tomography” AND “Phacoemulsification”. According to  STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist, the quality of each chosen article was evaluated. Results: We have selected five articles of prospective cohort studies, which involved 756 patients whom received topical NSAIDs (Nepafenac 0.3%, Ketorolac Tromethamine 0.4%Nepafenac 0.1%, , and Diclofenac 0.1%) in treatment group and 700 patients received Placebo (Artificial tears) in control group. There was significant difference of central macular thickness based on OCT results between NSAIDs and control (placebo) group after uneventful phacoemulsification. Additionally, NSAIDs used as a preventative before phacoemulsification procedure exhibited a significantly reduced rise in central foveal thickness compared to placebo. There were changes of central macular thicknes postoperatively, and were significantly different from preoperative. Conclusion: It has been demonstrated that topical NSAIDs successfully lower the incidence of Pseudophakic Cystoid Macular Edema following phacoemulsification.