Comparison of diclofenac and fluorometholone in preventing cystoid macular edema after small incision cataract surgery: a multicentered prospective trial.
OBJECTIVE
To compare a nonsteroidal topical solution (0.1% diclofenac) to a steroidal topical solution (0.1% fluorometholone) in preventing cystoid macular edema (CME) and disruption of the blood-aqueous barrier.


METHODS
A multicentered, prospective clinical trial was performed on eyes undergoing phacoemulsification followed by implantation of a foldable acrylic intraocular lens by the envelope technique. The presence and degree of cystoid macula edema (CME) was determined by fluorescein angiography. A breakdown of the blood-aqueous barrier was determined by laser flare-cell photometry.


RESULTS
Five weeks after surgery, CME was present in 3 of 53 eyes (5.7%) receiving diclofenac and in 29 of 53 eyes (54.7%) receiving fluorometholone. This difference was statistically significant (P < .001). The amount of flare in the anterior chamber at 3 days, 1, 2, 5, and 8 weeks after surgery was also significantly lower (P < .01-P < .001) in the diclofenac group. The degree of flare at 3 days, 1, 2, 5, and 8 weeks after surgery was significantly higher in eyes with CME (P < .001).


CONCLUSIONS
These findings suggest that diclofenac effectively prevents CME following cataract surgery and that CME is closely related to the breakdown of the blood-aqueous barrier.
Miyake
K
K
Miyake Eye Hospital, Nagoya, Japan.
Masuda
K
K
Shirato
S
S
Oshika
T
T
Eguchi
K
K
Hoshi
H
H
Majima
Y
Y
Kimura
W
W
Hayashi
F
F
D000368:Aged; D000867:Anterior Chamber / Q000473:pathology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D018916:Blood-Aqueous Barrier / Q000187:drug effects; D002452:Cell Count; D004008:Diclofenac / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D005469:Fluorometholone / Q000008:administration & dosage / Q000627:therapeutic use*; D015590:Fluorophotometry; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D008269:Macular Edema / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D018918:Phacoemulsification / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D004008:Diclofenac; D005469:Fluorometholone