PURPOSE: To investigate if a combination of topical nonsteroid anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a subtenon depot of steroid was placed during surgery.

SETTING: Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark.

DESIGN: Prospective randomized controlled trial with masked statistical analyses.

METHODS: Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eyedrops combined (groups Pred+NSAID-Pre [control group] and Pred+NSAID-Post) vs ketorolac monotherapy (groups NSAID-Pre and NSAID-Post) vs subtenon depot of dexamethasone (Dropless group). Drops were used until 3 weeks postoperatively, starting 3 days before surgery in the "Pre" groups and on the day of surgery in the "Post" groups. Aqueous flare was measured at baseline and 3 days postoperatively.

RESULTS: 456 participants, mean age 72.1 (SD 7.0) years, 283 (62%) females, were included. Flare increased significantly more in the Dropless group compared with control (Pred+NSAID-Pre), but none of the other groups differed significantly from the control. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eyedrops (Pred+NSAID-Pre and Pred+NSAID-Post) compared with NSAID monotherapy and Drop-less. No differences in postoperative visual acuity were found compared with control.

CONCLUSIONS: No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery but subtenon depot of dexamethasone was less efficient. Initiating prophylactic eyedrops prior to surgery did not influence early postoperative anterior chamber inflammation.