Prophylactic use of nonsteroidal anti-inflammatory drugs after cataract surgery and corneal melt

Topical NSAIDs impact on macular oedema and visual outcome after phacoemulsification: systematic review of RCTs with network meta-analysis

The aim of this Network Meta-analysis was to compare the efficacy of the different topical Nonsteroidal anti-inflammatory drugs (NSAIDs) when added or not to topical steroids in preventing the thickening of the macula and their impact on visual acuity and intraocular pressure after phacoemulsification. Five electronic databases were searched, including PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov. Our primary outcome was one-month post-surgery visual outcome. We also considered change in Foveal thickness (FT) and Intraocular pressure (IOP) at one-month post-surgery. We summarized our analyses by calculating the mean differences (MD) with associated 95% confidence intervals (CI) using restricted maximum likelihood in random effects models for continuous outcomes. The methodological quality of the studies was assessed with Cochrane Collaboration's tool. The network meta-analysis was conducted using frequentist approach considering Nepafenac 0.1% as a reference medication. Eleven Randomized controlled trials (RCTs) including 2175 subjects were selected for quantitative analysis. At one-month post-surgery, Bromfenac had statistically significant better visual acuity compared to Nepafenac 0.1% (p < 0.001), regarding FT, Nepafenac 0.3% had the least increase in FT compared to Nepafenac 0.1% (p = 0.09), regarding IOP, Diclofenac had the lowest IOP. No significant results regarding FT and IOP. Interestingly Ketorolac had the worst results regarding BCVA and IOP, and came last but one for FT. Overall, our network meta-analysis demonstrated that Bromfenac was associated with a significant improvement in visual acuity compared to Nepafenac 0.1% at one-month following cataract surgery, while Nepafenac 0.3% was associated with the least increase in foveal thickness.

NSAID-induced corneal melt as the first presentation of Sjögren's syndrome

A non-diabetic woman in her 80s presented 1 week following uncomplicated left eye cataract surgery complaining of decreased vision, gritty sensation and photophobia in the same eye. Postoperative treatment included G. Acular (Ketorolac Tromethamine 0.5%, NSAID: non-steroidal anti-inflammatory drug) and G. Tobradex (Tobramycin 0.3% and Dexamethasone 0.1%, antibiotic and steroid, respectively) each prescribed four times a day for 2 weeks. On examination, the patient had a corneal epithelial defect which progressed to a full-thickness perforation despite ceasing the NSAID drops. Cyanoacrylate glue application with a plastic drape patch failed to seal the perforation, and a full-thickness tectonic corneal transplant was performed. On investigation, the patient had positive anti-RO and anti-LA antibodies, suggesting a diagnosis of Sjögren's syndrome. We advocate for careful preoperative assessment prior to cataract surgery, patient education, close follow-up and cautious medication use postoperatively including avoiding NSAID drops in patients with risk factors for postoperative dry eye disease.

Corneal perforation after corneal foreign body - Case Report

Purpose: To present the case of a patient with a history of trauma and corneal foreign body in the right eye, followed by decreased visual acuity in the right eye, corneal perforation with good recovery after surgical treatment. Material and method: We report a case of a patient who presented to our clinic with a sudden decrease of visual acuity in the right eye, two months after an incident resulting in a corneal foreign body in the right eye. In the case presented, the patient applied a local medical self-treatment, an antibiotic and a topical corticosteroid. After a few weeks, the patient presented to the ophthalmologist, a foreign body was extracted from the cornea of the right eye and a topical treatment with a non-steroidal anti-inflammatory drug, a cycloplegic and an antibiotic were indicated. However, corneal perforation occurred and the patient was urgently sent to our service, where a corneal anaesthesia was also found. Results: Corneal perforation healed with a minor paracentral opacification. Discussions: Corneal perforation in our patient was due to corneal melting because of topical steroid anti-inflammatory autotherapy, late corneal foreign body extraction and topical treatment with non-steroidal anti-inflammatory drugs. Corneal anesthesia is also an important factor that enhances corneal melting and perforation. The surgical intervention performed healed the corneal perforation. Conclusions: Corneal anaesthesia and topical anti-inflammatory administration led to corneal perforation. Corneal sensitivity should be tested in patients with corneal foreign body. Corneal patching proved to be an adequate solution in this patient.