The latest findings from AAO 2016 have shown mandatory use of steroids in uncomplicated phaco to prevent CME and no additive benefit of any NSAIDS (bromphenac,etc.)

Ram a similar study in Nigeria, comparing ultracortenol(steroid) with Voltaren ophtha(NSAID) shows comparative efficacy as post up care for ECCE + IOL in cataract;

• But I think the phaco process and dynamics deliver more intraocular energy, turbulence and tissue reaction than obtainable with SICS

Hi all

Can you clarify some points regarding your study?

1. what was the 2 arms of your study? steroid alone vs. NSAID alone or steroid plus NSAID vs. NSAID alone?

2. what was your sample size in each arm?

3. for how long did you follow up the patients?

4.what was/were your outcome measures? (BCVA, CME, endophthalmitis, cell and flare....)

5. did you evaluate postop CME with OCT or...?

Purpose : To compare the efficacy of topical steroids vs NSAIDs in controlling inflammation following uncomplicated cataract surgery.

Material and Methods- 120 patients undergoing uncomplicated phaco surgery with IOL were divided in two groups of 60 each, while the 1st group received prednisolone drops 1% and other was put on bromfenac 0.09% exclusively. This was a prospective study carried out at Indira Gandhi Medical College Shimla.

Material and methods: Various Inflammatory parameters like limbal congestion, anterior chamber flare and cells, corneal haze, were studied on slit lamp biomicroscopy, at day 1, 3 and 6 weeks postoperatively. Best corrected Snellen acuity( BCVA)  was also recorded. The data was analysed using student T- test.

Results-  Both the drugs were equally effective in controlling postoperative anterior segment inflammation independently. None of the patient required additional substitution therapy to control inflammation.There was no statistically significant dIfference in BCVA and striate keratopathy (p

please find attached our locally published journal article on this subject

Many private consultants are using just NSAIDs and no steroids at all.

I don't have any personal experience, but Still initial short course of steroid with tapered dosage with supplemental NSAIDs later on is still most commonly used today.

In my experience but without documentation ,due to prevent of traumatic  iritis  during cataract surgery especially PE   and comforting of patient after cataract surgery corticosteroid eye drops is a good helper and it is more faster and  effective than NSAID drops . one of common side effect of NSAID is eye burning and many of patients complain  from this effect. however NSAID  in cases of more inflammation is a good adjutant medication. 

The intention to plan this study was derived from different factors

Mostly postoperative schedule of steroid is of ECCE era where intraocular manipulations were more and postoperative AC reaction was high and frequent use of steroid -1 hourly was routine and continued for 6 weeks.In cases where AC reaction is high it is justified today irrespective of technique.

Multiple drops were used- steroid+antibiotic, cycloplegic, NSAID, lubricant, antibiotic ointment. Most of the surgeon has stopped use of postoperative cycloplegia and double antibiotic, so do I. It goes without saying that multiple use of drugs have multiple problems.

CME is related intraocular manipulations, higher energy use, PCR and Vitreous disturbance. Use of Steroid + other drugs is justified in these situations and can be used. 

In uncomplicated surgery I found 6/6 vision on day one and nearly nil AC reaction, then why steroid or any NSAID even? Body has its on mechanism of healing and controlling inflammation, so why interfere. I wanted to make a third group of placebo in this study, which I deferred till the results of this study.

Vision did not deteriorate in any patient due to CME clinically (other study going on for CME-OCT based) but it improved to normal by 6 weeks in cases where it was less than 6/6 in early post operative period.

Dear Ram Lal Sharma,

Many thanks for your good work,

Inflammation after cataract surgery especially PE have more dependent  to experience of surgeon and  type of cataract density during surgery . I suggest new study with matching , for aging, sex , density calcification of cataract  and duration of surgery for every patient and any other finding like PXF syndrome and so...

Thanks Dr Shirzadeh for valuable opinion

         While softer and immature cataracts are easy to operate by phaco, but mature and calcified cataract pose definite challenges for PE. I am big fan of SICS surgery which is easier to perform in hard cataract with higher margin of safety than PE, and I prefer to do SICS in these situations and we have used NSAID alone following uncomplicated SICS also with similar response. We have done studies comparing SICS with Phaco where visual outcome is similar at 6 weeks

Sir, we agree with your view

Sir can a multi centre trial for the same be planned?

Yes Dr Gopal

would you send the proposal form especially methods and material section for evaluation please?

Actually NSAIDs are better than steroids in preventing CMO. However, we need to use an antibiotic post-operatively as well. So, we need to prescribe 2 drops. On the contrary, an antiotic-steroid combination eye drop is easier for the patient; as well as lowering the preservative load to the eye. In our hospital only Ketorolac is available, which stings a lot during instillation and probably produces more corneal toxicity.

Dear Dr Shoeb

               We use combination drops of antibiotic + NSAID drops, which are marketed by some suppliers, for better compliance and preservative reason as you told, although some pharmaceuticals question their efficacy and amount of drug reaching the eye. A single drop has far more volume than capacity of conjunctival sac.

It depends on individual case. Even then some cases with absolutely no reaction respond to NSAID drops initially, some require steroid drops intensively at the end of PO first week. This is due to multi factorial causes.

Dear Dr Rao

Thanks for the input 

There are some patients as you pointed out where unusual reaction is seen despite uneventful surgery, the cause could be explained in some with h/of trauma, inflammation which patient might have forgotten or some patients could have allergies to drugs,  viscoelastic, chemical, preservatives which are difficult to assess. Yes steroid will suppress them all so justified in such cases. 

Thanks for your comments. 

    Apart from the causes you mentioned, the sequestered antigens of lens expose to immune system in any ECCE, despite our perhaps total cortical cleanup and also in SICS sometimes lens material micro remnants remain in tunnel also pose the immune activation in the same eye, I think not reported so far.