Comparison of topical and intracameral nonsteroidal anti-inflammatory drugs on pupillary size and postoperative inflammation in cataract surgery

Abstract

Purpose The aim of this study was to compare the changes in pupillary size, postoperative inflammation, and macular thickness in patients who were subjected to phacoemulsification and received different topical and intracameral NSAIDs. Patients and methods This was a prospective randomized study that recruited 284 patients with visually significant cataract for whom uneventful phacoemulsification with intraocular lens implantation was performed. Candidates were randomly assigned to receive preoperative topical nepafenac, topical ketorolac, intraoperative intracameral ketorolac, or no NSAIDs. Results Topical nepafenac, topical ketorolac, and intracameral ketorolac had significantly maintained less intraoperative pupil size fluctuation than the placebo group (P=0.033, 0.001, and 0.048, respectively). In addition, topical nepafenac-treated, topical ketorolac-treated, and intracameral ketorolac-treated groups had less postoperative anterior chamber cells than the placebo group at 1 day (P=0.019, 0.421, and 0.515, respectively) and at 1 week, postoperatively (P=0.037, 0.089, and 0.298, respectively). However, at 1 month postoperatively, all study groups had similar minimal anterior chamber reaction with an insignificant difference (P=0.237, 0.379, and 0.342, respectively). Retinal thickness increased in all study groups 1 month after cataract surgery. However, topical and intracameral ketorolac groups had significantly less central macular thickness change as compared with the placebo (P=0.009 and 0.004, respectively). Conclusion The use of topical or intracameral NSAIDs yielded less intraoperative fluctuation in pupil size and lower postoperative inflammation than the placebo group. The topical nepafenac group had less postoperative inflammation, whereas the ketorolac-treated patients had the least changes in retinal thickness.