Increased Corneal Complications Found in GVHD Patients on Topical NSAIDs after Cataract Surgery

A recent study has raised concerns about the use of topical NSAIDs following cataract surgery in patients with ocular graft-versus-host disease. This group experienced a significantly greater rate of corneal complications within three months after surgery, leading the authors to suggest a need for caution among surgeons treating these patients. Photo: Christine Sindt, OD. Click image to enlarge. Cataract surgery is a common procedure required by patients suffering from ocular graft-versus-host disease (GVHD), a debilitating eye condition that can result from stem cell transplantation. While topical nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to prevent cystoid macular edema—a common complication following cataract surgery—their use in ocular GVHD patients has been debated due to potential adverse effects on the cornea. In a new study whose findings were presented on Sunday at ARVO 2025 in Salt Lake City, researchers found a significant association between the postoperative use of topical NSAIDs and an increased risk of corneal complications among ocular GVHD patients.The study was conducted at three medical sites and analyzed patients who underwent allogeneic stem cell transplantation and developed definite oGVHD, as classified by the International Chronic Ocular GVHD Consensus Group. Spanning from January 2014 to September 2023, it used the Mayo Clinic’s Ophthalmology Parametric Universal Search database to identify cases where patients showed symptoms of ocular GVHD and received topical NSAIDs within 45 days after surgery. Those lacking sufficient follow-up data were excluded. The study primarily investigated corneal complications within three months post-surgery.Out of 80 eyes from 58 patients (43% female; mean age at surgery: 58), topical NSAIDs were used in 10 eyes (13%) of nine patients (16%). Notably, there was a significantly higher occurrence of corneal complications—such as filamentary keratitis, corneal abrasions and corneal ulcers—in the group treated with topical NSAIDs (30%) compared to those who did not receive the drugs (6%). This difference was statistically significant, with a p-value of 0.024, indicating a strong link between topical NSAID use and increased corneal complications in this particular population.Given the retrospective nature of the study, further research is warranted to fully understand the risks and benefits of topical NSAIDs in this vulnerable group. However, the current evidence suggests that the use of these medications should be carefully considered, weighing the potential risks against the benefits to ensure the best outcomes for ocular GVHD patients undergoing cataract surgery.Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Sinha K, Lopez-Ruiz A, Buckner-Petty S, Shen JF. Corneal complications associated with topical nonsteroidal anti-inflammatory drug use following cataract surgery in patients with ocular graft-versus-host disease. ARVO 2025 annual meeting.