Reducing angiographic cystoid macular edema and blood-aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%

Author(s): Asano S, Miyake K, Ota I, Sugita G, Kimura W, Sakka Y, Yabe N

Affiliation(s): From the Shohzankai Medical Foundation Miyake Eye Hospital (Asano, Miyake, Ota) and Sugita Eye Hospital (Sugita), Nagoya; Kimura Eye and Internal Medicine (Kimura), Hiroshima; Sakka Eye Clinic (Sakka), Kitakyushu; and Oshima Eye Hospital (Yabe), Fukuoka, Japan.

Publication date & source: 2008-01, J Cataract Refract Surg., 34(1):57-63.

Publication type:

PURPOSE: To compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation. SETTINGS: Shohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan. METHODS: This multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood-aqueous barrier disruption was determined by laser flare-cell photometry. RESULTS: Of the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003). CONCLUSIONS: Diclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.