The Role of Perioperative Nonsteroidal Anti-Inflammatory Drugs Use in Cataract Surgery

Ari Brandsdorfer; Sejal H. Patel; Roy S. Chuck


Curr Opin Ophthalmol. 2019;30(1):44-49. 

In This Article

Preoperative Nonsteroidal Anti-inflammatory Drug use

Many cataract surgeons begin NSAID medications for their patients preoperatively to reduce intraoperative prostaglandin release and blunt postoperative inflammation. In 2017, Katsev et al.[1] obtained serial 100 μl samples of aqueous humor in 12 patients undergoing cataract surgery. Samples were obtained from patients who had received topical ketorolac three times over 24 h prior to surgery and were collected both after initial paracentesis, and prior to corneal wound hydration. Ketorolac concentrations were significantly reduced at the end of surgery compared with the beginning of surgery (P = 0.0022) with 66.7% of patients having undetectable levels at the end. Although the possible depot effect of preoperative ketorolac dosing in the vitreous cavity remains unclear, the authors noted that ketorolac's short half-life of 2.3 h and the removal of free drug by intraoperative irrigation likely renders the postoperative anti-inflammatory effects of preoperative ketorolac minimal. Therefore, they advocated for intraoperative ketorolac use.

Medic et al.[2] studied interleukin 12 (IL-12) concentration in the aqueous humor of 27 patients with diabetic retinopathy taking diclofenac 0.1% four times daily (Naclof, Exelsion, France) for 7 days prior to cataract surgery to 30 days following surgery compared with 28 patients who did not receive any perioperative NSAIDs. Samples taken after initial paracentesis found IL-12 concentrations were significantly reduced in the diclofenac group compared with control (33.4 ± 26.5 versus 57.7 ± 29.9 pg/ml; P = 0.007). Following surgery, patients in the diclofenac group had significantly lower central macular thickness (CMT) measurements by spectral OCT (Copernicus, OPTPOL Technology, Zawiercie, Poland). However, there was no difference in incidence of CME evident on OCT imaging between groups (37% treatment versus 43% control; P = 0.87).