Yonsei Med J.  2015 Nov;56(6):1671-1677. 10.3349/ymj.2015.56.6.1671.

The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

• Jung JW
• Chung BH
• Kim EK
• Seo KY
• Kim TI

• KMID: 2345899
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1671

Abstract

PURPOSE
To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery.
MATERIALS AND METHODS
A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation.
RESULTS
Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant.
CONCLUSION
Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Keyword

Non-steroidal anti-inflammatory drugs; miosis; ocular inflammation; macular edema

MeSH Terms

Aged
Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/pharmacology
Benzophenones/*administration & dosage/pharmacology
Bromobenzenes/*administration & dosage/pharmacology
*Cataract
*Cataract Extraction
Female
Humans
Inflammation/prevention & control
Ketorolac/*administration & dosage/pharmacology
Lens Implantation, Intraocular
Macular Edema/*prevention & control
Male
Middle Aged
Miosis/*prevention & control
Phacoemulsification
Postoperative Complications/drug therapy
Postoperative Period
Premedication
Treatment Outcome
Anti-Inflammatory Agents, Non-Steroidal
Benzophenones
Bromobenzenes
Ketorolac

Figure

• 

  Fig. 1 Comparison of summed ocular inflammation score (SOIS) between three groups at 1 week and 1 month after cataract surgery. The SOIS was sum of the scores of cells and flare16 (maximum possible total score=8). This score was significantly lower in both NSAID groups compared with the control (p<0.05), but it did not differentiate group 1 from group 2 (p>0.05). NSAID, non-steroidal anti-inflammatory drug.

• 

  Fig. 2 Comparison of changes in central foveal subfield thickness (A), macular thickness (B), and macular volume (C) using Spectralis optical coherence tomography after cataract operation between subgroups of patients without or with diabetes mellitus (DM). In group 3, changes in central foveal subfield (CSF) thickness, macular thickness, and macular volume measured before operation and at 1 month postoperatively were significantly different between patients without DM and those with DM (p>0.05). The changes in CSF thickness, macular thickness, and macular volume measured before operation and at 1 month postoperatively were not significantly different between patients without DM and those with DM in group 1, 2 (p>0.05).

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