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Anti‐inflammatory medication following cataract surgery: a randomized trial between preservative‐free dexamethasone, diclofenac and their combination
Author(s) -
Ylinen Petteri,
Holmström Emil,
Laine Ilkka,
Lindholm JuhaMatti,
Tuuminen Raimo
Publication year - 2018
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13670
Subject(s) - medicine , cataract surgery , dexamethasone , phacoemulsification , diclofenac , macular edema , surgery , randomized controlled trial , ophthalmology , retinal , anesthesia , visual acuity
Purpose To examine the anti‐inflammatory efficacy and tolerance between preservative‐free dexamethasone ( DEX ) and diclofenac ( DICL ) eye drops, and their combination following cataract surgery. Methods A randomized, double‐blind, prospective single‐centre study with 189 eyes of 180 patients undergoing routine cataract surgery. Laser flare meter measurement and spectral‐domain optical coherence tomography imaging were conducted before surgery and at the 28‐day postoperative visit. Clinical characteristics, surgical parameters and assessment of postoperative symptoms were recorded. Results Preoperative flare was 9.0 ± 0.6 pu/ms and central retinal thickness (CRT) 269.6 ± 1.9 μ m (mean ± SEM). On day 28, flare was 22.1 ± 2.9 pu/ms for DEX , 17.4 ± 2.5 pu/ms for DICL and 13.0 ± 1.6 pu/ms (p < 0.05) for their combination. Central retinal thickness (CRT) increase was 31.5 ± 8.8 μ m for DEX , 6.0 ± 0.8 μ m (p = 0.001) for DICL , and 3.5 ± 0.5 μ m (p < 0.001) for their combination. The incidence of ocular symptoms related to the eye drops was 11% for DEX , 37% for DICL and 34% for their combination (p < 0.001). Clinically significant pseudophakic cystoid macular oedema ( PCME ) was observed in seven eyes which were all treated with DEX (p < 0.001). Conclusion Diclofenac (DICL), as well as the combination of DEX and DICL , were superior to DEX monotherapy in minimizing CRT change and the incidence of PCME . Combination medication showed no added value compared to DICL monotherapy in uneventful cataract surgery.