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. 2025 Sep 18;18(9):1730-1736.
doi: 10.18240/ijo.2025.09.15. eCollection 2025.

Comparative efficacy of non-steroidal anti-inflammatory drugs in preventing postoperative macular edema following cataract surgery: a systematic review and Network Meta-analysis

Min Lang  1 , Jie Xuan  1 , Xue Li  1 , Ming-Ming Liu  1 , Jie Xu  1 , Ting Liu  1
Affiliations

Comparative efficacy of non-steroidal anti-inflammatory drugs in preventing postoperative macular edema following cataract surgery: a systematic review and Network Meta-analysis

Min Lang et al. Int J Ophthalmol. .

Abstract

Aim: To assess and rank the efficacy of various non-steroidal anti-inflammatory drugs (NSAIDs) in preventing postoperative macular edema (PME) after cataract surgery.

Methods: A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases. Randomized controlled trials (RCTs) comparing different NSAIDs and control treatments for the prevention of PME were included. Data from the studies were synthesized using the "gemtc" package in R. Risk of bias was assessed with the Cochrane RoB 2 tool, and heterogeneity was evaluated using the global I 2 statistic. Surface under the cumulative ranking curve (SUCRA) values were calculated for each treatment.

Results: Of 132 identified records, 9 RCTs met the inclusion criteria. The Network Meta-analysis indicated that nepafenac had the highest efficacy in preventing PME, followed by artificial tear substitute, ketorolac, diclofenac, and bromfenac. The league table comparisons and rankograms corroborated these findings, with nepafenac consistently ranking highest. Heterogeneity analysis yielded high I 2 values, indicating substantial variability across studies.

Conclusion: This Network Meta-analysis suggests that nepafenac is the most effective NSAID for preventing PME following cataract surgery. Given the substantial heterogeneity observed, further high-quality RCTs are required to confirm these findings and explore the sources of variability. Clinicians should consider these results when selecting NSAIDs for PME prophylaxis in cataract surgery patients.

Keywords: Network Meta-analysis; cataract surgery; nepafenac; non-steroidal anti-inflammatory drugs; postoperative macular edema.

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Conflict of interest statement

Conflicts of Interest: Lang M, None; Xuan J, None; Li X, None; Liu MM, None; Xu J, None; Liu T, None.

Figures

Figure 1
Figure 1. PRISMA flow diagram for study selection process
PRISMA flow diagram details the study selection process for the systematic review and Network Meta-analysis on the efficacy of various NSAIDs in preventing postoperative macular edema following cataract surgery. Out of the 132 records identified through database searches, no additional records were identified through other sources. After removing duplicates, 113 records were screened, resulting in the exclusion of 66 records for various reasons. Ultimately, 9 studies were included in both the qualitative and quantitative synthesis (Meta-analysis). PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; NSAIDs: Non-steroidal anti-inflammatory drugs.
Figure 2
Figure 2. Network plot of comparisons among different NSAIDs and controls
The network plot depicts the comparisons among various NSAIDs and control treatments used in the studies included in the Network Meta-analysis. Each node represents an intervention, with the size of the node being proportional to the number of studies involving that particular treatment. The connections (or edges) between the nodes signify direct comparisons made within the included studies. The NSAIDs compared in the network include nepafenac, diclofenac, ketorolac, and bromfenac. Control treatments such as dexamethasone, prednisolone acetate, fluorometholone, and artificial tear substitute are also represented. NSAIDs: Non-steroidal anti-inflammatory drugs.
See this image and copyright information in PMC

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