The effect of topical diclofenac on choroidal blood flow in early postoperative pseudophakias with regard to cystoid macular edema formation.
OBJECTIVE
To study the chronological change in choroidal blood flow (ChBFlow), disruption of the blood-aqueous barrier, and incidence of cystoid macular edema (CME) in early postoperative pseudophakic eyes, as well as the effect of nonsteroidal anti-inflammatory drug (NSAID) eye drops on these phenomena.


METHODS
Fifty patients who underwent phacoemulsification and foldable intraocular lens (IOL) implantation were randomized to receive either topical diclofenac or fluorometholone for 5 postoperative weeks. An additional 20 subjects, with long-standing pseudophakia served as the control. The blood-aqueous barrier was examined by laser flarimetry and choroidal blood velocity (ChBVel), volume (ChBVol), and ChBFlow by laser Doppler flowmetry (LDF) at 2 days and 1, 2, and 5 weeks after surgery. The incidence and severity of CME were evaluated by fluorescein angiography at 2 and 5 weeks after surgery.


RESULTS
Compared with patients taking diclofenac, those receiving fluorometholone showed significantly reduced ChBVol at 2 weeks (0.38 +/- 0.08 vs. 0.32 +/- 0.07, P = 0.022) and ChBFlow at 1 (11.01 +/- 1.74 vs. 9.35 +/- 1.51, P = 0.003) and 2 (11.15 +/- 1.43 vs. 8.47 +/- 1.27, P = 0.000) weeks after surgery, as well as a significantly elevated amount of anterior flare at 1 (8.9 +/- 2.2 vs. 24.4 +/- 18.9, P = 0.001) and 2 (9.2 +/- 3.5 vs. 16.7 +/- 12.3, P = 0.025) weeks after surgery. The ChBVol and ChBFlow in the fluorometholone group, however, returned to normal and was not different from the diclofenac group at 5 weeks after surgery. The incidence of fluorescein angiographic CME trended to be higher (P = 0.08) at 2 weeks and was significantly higher (P = 0.001) at 5 weeks after surgery in eyes with fluoromethalone than with diclofenac.


CONCLUSIONS
Reduction of ChBFlow, disruption of the blood-aqueous barrier, and incidence of CME in early postsurgical pseudophakic eyes were more effectively prevented chronologically in eyes treated with diclofenac than in those treated with fluorometholone.
Shohzankai Medical Foundation, Miyake Eye Hospital, Kita-ku, Nagoya, Japan. miyake@spice.or.jp
Kensaku
K
Miyake
Kazuo
K
Nishimura
Seiyo
S
Harino
Ichiro
I
Ota
Sayaka
S
Asano
Nagako
N
Kondo
Sampei
S
Miyake
D000287:Administration, Topical; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001783:Blood Flow Velocity / Q000187:drug effects; D018916:Blood-Aqueous Barrier / Q000502:physiology; D002829:Choroid / Q000098:blood supply*; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D005469:Fluorometholone / Q000008:administration & dosage; D006801:Humans; D017078:Laser-Doppler Flowmetry; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology*; D012039:Regional Blood Flow / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D005469:Fluorometholone