Comparison of the efficacy and patients' tolerability of Nepafenac and Ketorolac in the treatment of ocular inflammation following cataract surgery: A meta-analysis of randomized controlled trials.

Xinyu Zhao,Youxin Chen,Erqian Wang,Song Xia,James T Rosenbaum

doi:10.1371/journal.pone.0173254

Abstract

As a new ophthalmic non-steroidal anti-inflammatory drug (NSAID) with prodrug structure, Nepafenac was supposed to have a better efficacy than conventional NSAIDs both in patients’ tolerability and ocular inflammation associated with cataract surgery. However, many current studies reached contradictory conclusions on the superiority of Nepafenac over Ketorolac. The objective of our study is to evaluate the efficacy and patients’ tolerability of Nepafenac and Ketorolac following cataract surgery. To clarify this, we conducted a meta-analysis of randomized controlled trials. Eleven articles were included in this study. The dataset consisted of 1165 patients, including 1175 cataract surgeries. Among them, 574 patients were in the Nepafenac group and 591 in the Ketorolac group. Our analysis indicated that these two drugs were equally effective in controlling post cataract surgery ocular inflammation, reducing macular edema, achieving a better visual ability and maintaining intraoperative mydriasis during cataract surgery. However, Nepafenac was more effective than Ketorolac in reducing the incidence of postoperative conjunctival hyperemia and ocular discomfort. This meta-analysis indicated that topical Nepafenac is superior to Ketorolac in patients’ tolerability following cataract surgery. However, these two drugs are equally desirable in the management of anterior chamber inflammation, visual rehabilitation and intraoperative mydriasis. Given the limitations in our study, more researches with larger sample sizes and focused on more specific indicators such as peak aqueous concentrations of drugs or PEG2 levels are required to reach a firmer conclusion.

Highlights

With the significant progress in surgical techniques and apparatus such as phacoemulsification, modern cataract surgery has achieved a reduction of physical surgical trauma and a PLOS ONE | DOI:10.1371/journal.pone.0173254 March 2, 2017Comparison of Nepafenac and Ketorolac for ocular inflammation following cataract surgery decrease in the release of prostaglandins, which plays the main role in the progress of postoperative ocular inflammation [1, 2]
Nepafenac may have a better efficacy than conventional non-steroidal anti-inflammatory drug (NSAID) both in patient tolerability and ocular inflammation associated with cataract surgery
Nepafenac may have a better efficacy than conventional NSAIDs like Ketorolac both in patients’ tolerability and ocular inflammation associated with cataract surgery

Summary

Introduction

With the significant progress in surgical techniques and apparatus such as phacoemulsification, modern cataract surgery has achieved a reduction of physical surgical trauma and a PLOS ONE | DOI:10.1371/journal.pone.0173254 March 2, 2017Comparison of Nepafenac and Ketorolac for ocular inflammation following cataract surgery decrease in the release of prostaglandins, which plays the main role in the progress of postoperative ocular inflammation [1, 2]. Uncontrolled intraocular inflammation may disrupt the blood-ocular barrier and cause the entry of inflammatory cells and cytokines into aqueous humor, leading to patient discomfort, delayed recovery, suboptimal visual outcomes and even further complications such as cystoid macular edema (CME), synechiae formation, raised intraocular pressure (IOP), corneal edema, intraoperative miosis, hyperemia, photophobia and so on [2,3,4]. The obvious advantages of NSAIDs over corticosteroids include relative stable IOP, lower risk of secondary infections and extra benefit of analgesia [8,9] These make NSAIDs a promising agent for cataract surgery

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