A recent study published in Ophthalmology compared the safety and efficacy of standard steroids (prednisolone acetate 1% or dexamethasone 0.1%) versus soft topical steroids (fluorometholone 0.1% or loteprednol etabonate 0.5%) in the postoperative management of cataract surgery-induced inflammation.
Why compare the two steroid subgroups?
While the surgical technique of cataract surgery is relatively standard, the postoperative regimen differs greatly between physicians.
Topical steroid drops may vary in their potency and anterior chamber (AC) penetration rates, with higher potency promoting faster ocular inflammation control and an unfortunate potential higher risk of side effects—namely intraocular pressure (IOP) elevation.
As a result, an international research team sought to review high-quality data to identify the risks and benefits of various drugs to aid clinicians in determining appropriate steroid treatment.
Talk about the study.
In this meta-analysis study, investigators searched PubMed, Scopus, and Embase for peer-reviewed randomized control trials with clinical outcomes of topical steroid treatment after uneventful cataract surgery.
Study data was extracted and evaluated in a weighted pool analysis, including grading of the total:
- AC inflammation
- AC cells
- AC flare
- Postoperative visual acuity (VA)
- IOP
- Rate of adverse events
Tell me more.
Researchers analyzed 508 studies and included seven that were eligible for systematic review, resulting in reporting on a total of 593 patients from five countries.
The age of the included patients (when available) ranged from 3.7 to 73.4 years, and follow-up data was available for analysis at 1, 7, and 28 days following cataract surgery.
Findings?
Across the studies, the key difference between standard and soft topical steroids was a significantly lower grade of AC flare in the standard steroid group at day 1 (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.05, 0.47).
However, inflammatory activity measurements demonstrated insignificant differences at every other postoperative follow-up (i.e., days 1 and 28).
What about IOP and adverse events?
A pooled analysis of IOP at each follow-up indicated a higher IOP at the 7-day visit in the standard steroid group, although IOP at other time points was comparable between the groups.
Additionally, qualitative analysis of ocular adverse events suggested similarities in outcomes between standard and soft topical steroids.
Expert opinion?
Per the study authors, “Safety and potency should still be considered for the individual patient with either an increased tendency for postoperative inflammation or pre-existing glaucomatous damage to the operated eye.”
“In the absence of such characteristics, additional factors may also influence treatment regimen choice, including cost and local availability of the topical steroids,” they added.
Take home.
These findings indicate that for an average patient, both standard and soft topical steroids result in comparable effects on postoperative AC inflammation, IOP, and VA.