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

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 μm 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.

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

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 flare (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).