Loteprednol a Viable Treatment for Post-cataract Surgery Pain

Despite there being a higher IOP eight days postoperatively in the loteprednol etabonate group compared with placebo, this difference was not clinically significant, adding to the findings that loteprednol has a favorable safety profile compared with other steroids. The above photo (not from a study subject) shows corneal swelling and endothelial folds at a one-day cataract surgery post-op. Photo: Derek Cunningham, OD. Click image to enlarge. Following cataract surgery, pain is a common complaint stemming from the trauma to the anterior eye. Steroids and NSAIDs are the most used anti-inflammatory drugs post-cataract surgery but the latter is sometimes preferred to avoid the risks of intraocular pressure (IOP) elevation associated with steroids. When a steroid is used, prednisolone is commonly prescribed because of its strong anti-inflammatory effect, whereas NSAIDs are less prescribed because of potential complications like corneal ulcers and melting.To date, no systematic review and meta-analysis has evaluated the clinical efficacy and safety of loteprednol etabonate after cataract surgery. A recent study in Eye & Contact Lens was the first meta-analysis conducted on this topic to assess the efficacy and safety of loteprednol on post-cataract pain and inflammation. As loteprednol is an ester-based steroid rather than a ketone-based one like prednisolone, the medication demonstrated significant efficacy in alleviating post-op pain and inflammation, with notable advantages in safety, including minimal impact on intraocular pressure and reduced adverse events.This systematic review identified eight clinical trials (n=3,332) fulfilling research criteria. The primary outcome was the proportion of patients with complete resolution of anterior chamber inflammation and grade zero pain.The meta-analysis found that loteprednol significantly improved anterior chamber inflammation resolution vs. placebo at eight, 15 and 18 days postoperatively (risk ratio; RR=2.25, 2.11 and 2.06, respectively). The steroid also increased the likelihood of achieving no pain at three, eight, 15 and 18 days post-op (RR=1.54, 1.66, 1.70 and 1.92, respectively) and reduced the need for rescue therapy (RR=0.47) while maintaining no change in IOP after three, 15 and 18 days.“Such findings may call for a revision of the existing recommendations regarding the use of postoperative corticosteroids, indicating loteprednol etabonate as a better option,” the researchers wrote in their paper. “The strong chemical and pharmacokinetic properties of the drug provide a rationale for its efficiency and safety, thus making loteprednol etabonate a great addition for the management of postoperative patients and improving their clinical outcomes while avoiding the side effects that are usually related to other corticosteroids.”The meta-analysis emphasized the medication’s efficacy in dealing with pain in the immediate postoperative phase with continued superiority in reducing inflammation at later stages compared with placebo.It concluded that loteprednol etabonate should be considered in clinical practice as part of postoperative care protocols, potentially leading to improved patient comfort and outcomes while mitigating the risks commonly associated with corticosteroid use. Click here for the journal source. Elettreby AM, Alsaied MA, Saleh MM, et al. Efficacy and safety of loteprednol etabonate in managing pain and inflammation after cataract surgery: a systematic review and meta-analysis. Eye Contact Lens. August 20, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.