Efficacy and Safety of Loteprednol Etabonate in Managing Pain and Inflammation After Cataract Surgery: A Systematic Review and Meta-analysis

Objectives: This systematic review aims to evaluate loteprednol etabonate's efficacy and safety in reducing post-cataract pain and inflammation. Methods: A literature search was conducted to identify randomized controlled trials comparing loteprednol etabonate and placebo for post-cataract pain and inflammation. The primary outcome was the proportion of patients with complete resolution of anterior chamber inflammation (ACI) and grade zero pain. The quality of the studies was assessed using the RoB 2 tool, and a meta-analysis was performed using RevMan 5 software. Results: This systematic review identified eight clinical trials (n=3,332 patients) fulfilling research criteria. Meta-analysis results showed that loteprednol etabonate significantly improved ACI resolution compared with placebo at 8, 15, and 18 days postoperatively (RR=2.25, 2.11, and 2.06, respectively, with a P value <0.00001). Loteprednol etabonate also increased the likelihood of achieving no pain (RR=1.54, 1.66, 1.70, and 1.92, respectively, with a P value <0.00001) and reduced the need for rescue therapy (RR=0.47, P <0.00001) while maintaining no change in IOP after 3, 15, and 18 days. Conclusion: Loteprednol etabonate demonstrates significant efficacy in alleviating pain and inflammation post-cataract surgery, with notable advantages in safety, including minimal impact on intraocular pressure and reduced adverse events.