Pretreatment with topical diclofenac sodium to decrease postoperative inflammation.
OBJECTIVE
Anti-inflammatory medications are traditionally administered to the eye only postoperatively for control of inflammation. Because the presumed mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is to inhibit the formation of prostaglandin mediators of inflammation, the author studied the effect that pretreatment with an NSAID had on postoperative inflammation.


METHODS
In a prospective study, 60 patients scheduled for phacoemulsification with silicone lens implantation were randomly assigned to receive either (1) pretreatment with one drop of diclofenac sodium 0.1% four times per day for the 3 days before surgery plus one drop of diclofenac sodium 0.1% every 15 minutes for four doses, beginning 1 hour before surgery along with the dilating drops; (2) no pretreatment, but one drop of diclofenac sodium 0.1% every 15 minutes for four doses beginning 1 hour before surgery along with the dilating drops; or (3) no diclofenac sodium drops at all before surgery. No anti-inflammatory medications were given either during or immediately after surgery, and all patients were begun on a regimen of one drop of diclofenac sodium 0.1% to the operated eye four times per day after being examined on the first postoperative day. Postoperative inflammation was measured on the first postoperative day and at 1 week with a laser cell and flare meter.


RESULTS
On the first postoperative day, the mean flare score for group A was 25.59 photons/millisecond; for group B, 29.69 photons/millisecond; and for group C, 33.07 photons/millisecond. The difference between groups A and C was statistically significant. The differences between groups A and B and between groups B and C were not statistically significant. There was no statistically significant difference for cell scores at 1 day or for cell or flare scores at 1 week.


CONCLUSIONS
The pretreatment with an NSAID before cataract surgery can reduce the amount of initial postoperative inflammation.
Roberts
C W
CW
Department of Ophthalmology, Cornell University Medical College, New York.
D000287:Administration, Topical; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D009877:Endophthalmitis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007910:Lenses, Intraocular; D018918:Phacoemulsification / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D016037:Single-Blind Method
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac