Postoperative treatment with topical diclofenac versus topical dexamethasone
after combined phacotrabeculectomy with mitomycin C.
Author(s): Levkovitch-Verbin H(1), Katz G, Kalev-Landoi M, Goldenfeld M.
Affiliation(s): Author information:
(1)Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
hani_levkovitch-verbin@hks10.harvard.edu
Publication date & source: 2013, J Glaucoma. , 22(3):177-82
OBJECTIVE: The objective of the study was to compare the efficacy and safety of
topical dexamethasone sodium phosphate 0.1% (Sterodex) to diclofenac sodium 0.1%
(Voltaren Ophthalmic) after combined phacotrabeculectomy with mitomycin C.
METHODS: This prospective, randomized, double-masked clinical trial includes 42
patients with glaucoma and cataract who underwent a combined phacotrabeculectomy.
Patients were randomly assigned to postoperative treatment with topical
diclofenac sodium 0.1% or topical dexamethasone phosphate 0.1%. Follow-up
duration was 12 months and all examinations were masked. The main outcome
measures were intraocular pressure (IOP), number of glaucoma medications, and
bleb morphology.
RESULTS: Baseline characteristics of the diclofenac (n=21) and dexamethasone
(n=21) patients were similar. Phacotrabeculectomy with both postoperative
treatments was effective in reducing IOP, lowering the number of glaucoma
medications and improving visual acuity at all follow-up points. The average
number of medications taken by the dexamethasone group was significantly greater
than the diclofenac group at 8 months (1.2 ± 1.4 and 0.3 ± 0.6, respectively,
P=0.03). The mean bleb height of the diclofenac group was significantly higher
than the dexamethasone group at 3 weeks (P=0.05), and the mean bleb width was
significantly wider at 8 months (P=0.04). No significant group differences in IOP
were found at any of the follow-up visits, although there was a clinical trend
toward lower IOP values in the diclofenac group. Sixteen patients (76%) in the
diclofenac group and 17 patients in the dexamethasone group (81%) completed 1
year of follow-up.
CONCLUSIONS: In this preliminary study, diclofenac sodium is at least as good as
topical dexamethasone phosphate for glaucoma patients undergoing two-site
combined phacotrabeculectomy with mitomycin C.
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