Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis
Objective Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.Design Systematic review and...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e026752.full |
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| author | Mahmoud Tawfik KhalafAllah Ahmed Basiony Ahmed Salama |
| author_facet | Mahmoud Tawfik KhalafAllah Ahmed Basiony Ahmed Salama |
| author_sort | Mahmoud Tawfik KhalafAllah |
| collection | DOAJ |
| description | Objective Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.Design Systematic review and meta-analysis.Data sources Medline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references’ lists of the relevant articles.Eligibility criteria Randomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.Data extraction and synthesis Two independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.Results We included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).Conclusion With low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively. |
| format | Article |
| id | doaj-art-0de7f8d3a7254010b6c2518819945e0a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-0de7f8d3a7254010b6c2518819945e0a2024-11-27T09:20:08ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2018-026752Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-AnalysisMahmoud Tawfik KhalafAllah0Ahmed Basiony1Ahmed Salama2Ophthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, EgyptOphthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, EgyptOphthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, EgyptObjective Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.Design Systematic review and meta-analysis.Data sources Medline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references’ lists of the relevant articles.Eligibility criteria Randomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.Data extraction and synthesis Two independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.Results We included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).Conclusion With low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.https://bmjopen.bmj.com/content/9/11/e026752.full |
| spellingShingle | Mahmoud Tawfik KhalafAllah Ahmed Basiony Ahmed Salama Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis BMJ Open |
| title | Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis |
| title_full | Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis |
| title_fullStr | Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis |
| title_full_unstemmed | Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis |
| title_short | Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis |
| title_sort | difluprednate versus prednisolone acetate after cataract surgery a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/9/11/e026752.full |
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