No study described intraocular inflammation in terms of cells and flare as a dichotomous variable and there was not enough continuous data for anterior chamber cell and flare to perform a meta-analysis . One study reported presence of corneal edema at various times. Postoperative treatment with neither a combination treatment with a NSAID plus corticosteroid or with corticosteroid alone was favored ( RR , 95% CI to ). We judged this study to have high risk of reporting bias , and the certainty of the evidence was downgraded to moderate. No included study reported the proportion of participants with BCVA better than 20/40 at one week postoperatively or reported time to cessation of treatment. Only one included study reported on the presence of CME at one week after surgery and one study reported on CME at two weeks after surgery. After combining findings from these two studies, we estimated with low-certainty evidence that there was a lower risk of CME in the group that received NSAIDs plus corticosteroids ( RR , 95% CI to ). Seven RCTs reported the proportion of participants with CME at one month postoperatively; however there was low-certainty evidence of a lower risk of CME in participants receiving an NSAID plus a corticosteroid compared with those receiving a corticosteroid alone ( RR , 95% CI to ). The few adverse events reported were due to phacoemulsification rather than the eye drops.
Excellent points Jeff and Phillip. I am particularly concerned about the increasingly diminishing options for the elderly in chronic pain – to further narrow options by potentially excluding low systemic absorption, safe and effective NSAID topicals by painting them with a broad “ADE risk” brushstroke is terrible. And, if you want to follow the ultimate thought experiment on this topic, a potential discrimination against a vulnerable population. I support a change in labeling regarding a lack of evidence to support the new warnings for topical products.