Efficacy And Safety Of Hypertonic Saline In Postoperative Corneal Edema: A Systematic Review And Meta-Analysis

Postoperative corneal edema is commonly managed using hypertonic saline eye drops despite limited consolidated evidence supporting their clinical benefit. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of topical hypertonic saline (3–5% sodium chloride) compared with standard postoperative care in reducing corneal edema and improving visual outcomes following uneventful cataract surgery.

Systematic review and meta-analysis of published clinical studies conducted across multiple international ophthalmology centers involving patients with postoperative corneal edema following phacoemulsification cataract surgery.

A systematic review was performed according to PRISMA guidelines with searches of Medline, Embase, Web of Science, and Cochrane Library through March 2024. Randomized controlled and observational studies comparing topical hypertonic saline with standard postoperative care were included. Primary outcomes were change in central corneal thickness and logMAR visual acuity at 7 and 30 days. Data were pooled using a random-effects model. Adverse events were analyzed descriptively.

Fifteen studies were identified, with four studies comprising 297 eyes included in quantitative meta-analysis. At 7 days, both hypertonic saline and standard care demonstrated nonsignificant reductions in pachymetry and visual acuity improvement. At 30 days, standard postoperative care showed a significant reduction in corneal thickness, whereas hypertonic saline demonstrated no statistically significant advantage. No significant visual acuity differences were observed at any time point. Mild transient burning occurred in approximately 9% of patients receiving hypertonic saline, with no serious adverse events reported.

Hypertonic saline eye drops did not demonstrate superiority over standard postoperative care in reducing corneal edema or improving visual acuity after uncomplicated cataract surgery. Their clinical benefit appears limited to short-term symptomatic relief rather than sustained anatomical or functional improvement. Further adequately powered randomized trials with standardized outcome measures are required to define their role in postoperative corneal edema management.