{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:04:26Z","timestamp":1792004666676,"version":"4.4.0"},"reference-count":17,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,27]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references\u2019 lists of the relevant articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Randomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1\u2009week (OR=2.5, p&gt;0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1\u2009day (OR=2.6, p=0.02) and 1\u2009week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1\u2009month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026752","type":"journal-article","created":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T10:05:42Z","timestamp":1572689142000},"page":"e026752","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7973-5883","authenticated-orcid":false,"given":"Mahmoud Tawfik","family":"KhalafAllah","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Basiony","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Salama","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,11,2]]},"reference":[{"key":"2025121400380366000_9.11.e026752.1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.15-17201"},{"key":"2025121400380366000_9.11.e026752.2","doi-asserted-by":"crossref","unstructured":"Pager CK . Expectations and outcomes in cataract surgery. Arch Ophthalmol 1788;2004.","DOI":"10.1001\/archopht.122.12.1788"},{"key":"2025121400380366000_9.11.e026752.3","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/112067210701700104","article-title":"Outcomes of acute postoperative inflammation after cataract surgery","volume":"17","author":"Mohammadpour","year":"2007","journal-title":"Eur J Ophthalmol"},{"key":"2025121400380366000_9.11.e026752.4","doi-asserted-by":"publisher","DOI":"10.1097\/00055735-200102000-00002"},{"key":"2025121400380366000_9.11.e026752.5","doi-asserted-by":"crossref","unstructured":"Juthani VV , Clearfield E , Chuck RS . Non-Steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database Syst Rev 2017;7.doi:10.1002\/14651858.CD010516.pub2","DOI":"10.1002\/14651858.CD010516.pub2"},{"key":"2025121400380366000_9.11.e026752.6","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0706736"},{"key":"2025121400380366000_9.11.e026752.7","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.2147\/OPTH.S12441","article-title":"Dose uniformity of topical corticosteroid preparations: difluprednate ophthalmic emulsion 0.05% versus branded and generic prednisolone acetate ophthalmic suspension 1%","volume":"4","author":"Stringer","year":"2010","journal-title":"OPTH"},{"key":"2025121400380366000_9.11.e026752.8","unstructured":"Food Drug Administration Center for Drugs Evaluation Research . Guidance for industry: Waiver of in vivo bioavailability and bioequivalence studies for immediate-release solid oral dosage, 2008: 3\u20135."},{"key":"2025121400380366000_9.11.e026752.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.09.024"},{"key":"2025121400380366000_9.11.e026752.10","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/eye.2016.244","article-title":"Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study","volume":"31","author":"Wilson","year":"2017","journal-title":"Eye"},{"key":"2025121400380366000_9.11.e026752.11","first-page":"NC05","article-title":"To study the effectiveness of Difluprednate ophthalmic emulsion and prednisolone acetate ophthalmic suspension on post-operative inflammation in cataract surgery","volume":"10","author":"Garg","year":"2016","journal-title":"J Clin Diagnostic Res"},{"key":"2025121400380366000_9.11.e026752.12","first-page":"51","article-title":"To study the effectiveness of difluprednate ophthalmic emulsion and prednisolone acetate ophthalmic suspension on post-operative inflammation in cataract surgery","volume":"15","author":"Manna","year":"2016","journal-title":"J Dent Med Sci"},{"key":"2025121400380366000_9.11.e026752.13","unstructured":"Devi RHS , Nagabushan H , Manjula TR , et al . A comparative study of effectiveness and safety of difluprednate ophthalmic emulsion 0.05% with prednisolone acetate ophthalmic suspension 1% for managing ocular inflammation and pain following cataract surgery. Indian J Pharmacol 2014;46."},{"key":"2025121400380366000_9.11.e026752.14","unstructured":"Gundakalle S , Rekha BK . The Effectiveness of Topical Difluprednate Ophthalmic Emulsion 0.05% versus topical prednisolone acetate 1% Ophthalmic suspension in Control of Post \u2013 Operative inflammation following cataract surgery at KLES Dr. Prabhakar Kore Hospital Belgaum \u2013 A One year do. Jawaharlal Nehru Medical College, 2013."},{"key":"2025121400380366000_9.11.e026752.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2011.03.018"},{"key":"2025121400380366000_9.11.e026752.16","doi-asserted-by":"crossref","unstructured":"de Silva SR , Riaz Y , Evans JR , et al . Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev 2014;25.doi:10.1002\/14651858.CD008812.pub2","DOI":"10.1002\/14651858.CD008812.pub2"},{"key":"2025121400380366000_9.11.e026752.17","doi-asserted-by":"crossref","first-page":"811","DOI":"10.2147\/OPTH.S6541","article-title":"Difluprednate for the prevention of ocular inflammation postsurgery: an update","volume":"5","author":"Donnenfeld","year":"2011","journal-title":"OPTH"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026752","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T08:38:09Z","timestamp":1765701489000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11,2]]},"published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1136\/bmjopen-2018-026752"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026752","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}