CATARACT EWAP MARCH 2023 25 Contact information Hoffman: rshoffman@finemd.com Shorstein: nshorstein@seva.org T he use of NSAIDS in the context of cataract surgery remains a hot topic among surgeons. In 2015, the American Academy of Ophthalmology published the Topical Nonsteroidal Anti-inflammatory Drugs and Cataract Surgery OTA, which concluded that 1) “there is a lack of level 1 evidence that supports the long-term benefit of NSAID therapy to prevent vision loss from CME … ” and 2) there is no evidence that preop NSAID use “[affects] long-term visual outcomes.” 1 Following this report, in 2016 the ASCRS Cataract Clinical Committee published a paper in the Journal of Cataract & Refractive Surgery calling out NSAIDs’ “history of significant safety and demonstrable effectiveness.” 2 “Topical NSAIDs have What’s up with NSAIDs? by Liz Hillman Editorial Co-Director been useful in preventing intraoperative miosis, postoperative inflammation, and the development of CME,” the authors wrote. “In addition, they may modulate postoperative pain and inhibit the proliferation of LECs that are responsible for PCO. Nonsteroidal anti-inflammatory drugs have a synergistic effect with steroids on the development of CME but may be used alone in high-risk eyes in which topical steroid use may be detrimental. Whether used solely in eyes at increased risk for the development of CME or universally in all patients having cataract surgery, the benefits of these topical medications should be assessed by each clinician as appropriate for their particular practice or patient population. … A thorough understanding of the potency, approaches for avoiding and treating CME, and adverse reactions and contraindications of these medications should help surgeons maximize their benefits and improve surgical outcomes and patient satisfaction.” EyeWorld spoke with Richard Hoffman, MD, and Neal Shorstein, MD, who were both authors on this paper, to hear their current perspectives on NSAID use in the context of cataract surgery. Dr. Hoffman said there are “a whole host of different anti-inflammatory products for cataract surgery, including steroids and nonsteroidals.” In the latter category, he said topical NSAIDs are the mainstay, but intracameral administration is now an option with Omidria (phenylephrine and ketorolac intraocular solution, Rayner). The biggest impediment for the use of many of these products is the expense. “Older Dr. Shorstein said his practice has been to inject steroid as the sole anti-inflammatory agent following routine cataract surgery. Source: Neal Shorstein, MD This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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