Medications have gone far and become complex as to how and what they work for. There are drugs that are used directly to treat simple illnesses and conditions, and there are also some that work synergistically with others to achieve a desired effect.
Both counteract the effects of inherent chemicals in the body called prostaglandins which promote inflammation, fever, and pain. Prostaglandins also serve different purposes in the body.
These medications also contain antipyretic, anti-inflammatory, and analgesic properties in one drug. It is used to treat cases of mild to moderate pain as a result of surgery or other inflammation-inflicting illnesses. NSAIDS are also used as generalized symptom treatment ranging from arthritis, headache, fever, and gout. It is important to determine contraindications with other drugs such as diuretics and Warfarin to prevent the reduction of therapeutic effects and other untoward effects.
Meanwhile, steroids cover a more diverse classification. But, these events may stem from the procedure itself. For patients undergoing cataract surgery, NSAIDs used to be reserved only for cases of postoperative cystoid macular edema. Initiation of the NSAID before cataract surgery is also beneficial, as it allows the drug to reach therapeutic levels prior to the surgery.
The peer-reviewed literature suggests that in uncomplicated cases, NSAID therapy should start at least one day preoperatively and continue for at least three to four weeks postoperatively.
With patients rising expectations of outcomes for modern cataract surgery, preventing the most common cause of decreased vision becomes critical. It is even more paramount with refractive IOLs because even a slight degradation in acuity makes for a less-than-optimal outcome. NSAIDs have been used for years with rare side effects. But when side effects do occur, they can be quite serious. Subsequent investigations tried to elucidate who might be at risk of corneal melt from a topical NSAID.
They also were more likely to have a pre-existing ocular comorbidity and to use the NSAID for a non-surgical vs. Systemic disease has also been studied as a predisposition to corneal melting. Rheumatoid arthritis and diabetes mellitus are most often implicated, but studies have been conflicting about their association with corneal melting.
The exact chemical etiology of the melt remains questionable as well. NSAIDs may suppress keratocyte proliferation, a necessary component in corneal remodeling. Another hypothesis: NSAIDs selective blockade of the cyclo-oxygenase pathway may allow all unused arachidonic acid to enter the lipoxygenase pathway, resulting in a large concentration of leukotrienes that subsequently recruit neutrophils.
Neutrophils release collagenase and other enzymes that may potentiate corneal melting. Less serious side effects of topical NSAIDs include temporary decreased corneal sensation, superficial punctate keratitis and subepithelial infiltrates.
Topical NSAIDs allow us to treat some characteristics of inflammation without the complications of steroids. They may also work synergistically with steroids, providing a better treatment than either drug alone. Nothing beats a steroid when we need to quell all aspects of inflammation. While no new steroids have been recently released, the hot topic in this class is new drug delivery systems. These new systems release a steady supply of medication over an extended period of time.
There are two approaches to the new drug delivery systems: a reservoir-style implant that releases a steady supply of drug over a long period of time and a biodegradable implant that releases a drug over a much shorter time frame. Both have their inherent advantages and disadvantages. Reservoir implants can last well more than two years, providing a fixed concentration of the drug.
These implants may be more difficult to insert initially, but they require less replacement. Because the steroid is used over a longer time, however, patients are more prone to side effects.
The biodegradable implant provides a more pulsed drug delivery. The drug is typically delivered for one to three months before the implant dissolves. Many of these newer systems can be injected into the eye without surgery. Also, the shorter time frame of treatment should mean fewer side effects from the steroids. Current and forthcoming implants include:. This is the first steroidal intravitreal implant approved for use in the United States.
Retisert consists of a tiny reservoir 0. The 2. The reservoir is attached to a strut that can be sutured in the posterior segment. Retisert was initially approved in for use in chronic noninfectious uveitis. On the downside, side effects often occurred. Within an average post-implantation period of two years, nearly all phakic eyes are expected to develop cataracts.
Although frequent, these complications can be successfully managed and can be less deleterious than the alternative: uncontrolled inflammation. Look for new uses of Retisert in treating diabetic macular edema and wet age-related macular degeneration. Your physician will advise you regarding your ability to return to activity while using medication. Those taking NSAIDs should stay well hydrated to decrease the risk of kidney damage while exercising. Steroid injection around tendons may increase the risk of tendon tears, and a period of rest and rehabilitation is usually recommended before returning to full activity.
Sports medicine physicians are specially trained to determine whether steroids or NSAIDs, and in which form, would most benefit you in the healing process. Physicians may be able to perform injections with ultrasound guidance to direct the medicine to the affected area. NSAIDs and corticosteroids should rarely be used alone to treat musculoskeletal conditions. These medications serve to reduce pain, while a rehabilitation program is used to restore your pre-injury function. References Brukner, P.
North Ryde: McGraw-Hill. There were also no between-group differences in joint swelling, erythema, tenderness, or activity limitations.
The investigators discovered that patients who took corticosteroids had a lower risk of indigestion in three RCTs with patients RR, 0.
This meta-analysis was limited by the small number of clinical trials available for inclusion, which prevented the estimate of a number of outcomes and subgroup analyses.
There was also a high risk of bias in many of the studies.
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