ANTIINFLAMMATORY EFFECTS AND AQUEOUS-HUMO R CONCENTRATIONS OF DIFFERENT NONSTEROIDAL ANTIINFLAMMATORY DRUGS IN EXTRACAPSULAR CATARACT-SURGERY

Background Within the spectrum of anti-inflammatory drugs, the prefere nce of nonsteroidal anti-inflammatory drugs (NSAID) is definitely incr easing. In the present study, we compared the anti-inflammatory effect s and aqueous humour concentrations of 3 topical NSAID (indomethacin, diclofenac, and flurbiprofen) during extracapsular cataract surgery. P atients and methods We examined 90 patients (52-89 yrs of age) without pre-existing deficiencies of the blood-aqueous barrier. In 60 of thes e patients (series 1), an examination using the laser flare-cell meter was performed prior to and following extracapsular cataract surgery w ith intraocular lens implantation. In 30 patients (series 2), aqueous humour was drawn intraoperatively, and the NSAID concentration was det ermined using high-pressure liquid chromatography (HPLC). Patients wer e randomly assigned to one of the following three treatment protocols with commercially available NSAID: protocol A: indomethacin 1% eyedrop s (Chibro-Amuno(R)-3); protocol B: diclofenac 0.1% eyedrops (Vol taren (R) ophtha); protocol C: flurbiprofen 0.03% eyedrops (Ocuflur(R)). 2 d rops of either drug were administered as follows: day before surgery ( 4:00 p.m., late night), day of surgery (2, 1, and 1/2 hrs preop, end o f operation, 4:00 p.m., late night), and days 1-3 postoperatively (5 t imes per day). Results Under indomethacin therapy (protocol A), the ha re [in photon counts/ms] increased from a preoperative value of 8.0 +/ - 2.8 (means +/- SE) to 20.1 +/- 2.2 on day 1 postoperatively, and dec reased to 16.9 +/- 2.5 on day 3. Under diclofenac therapy (protocol 2) , the flare averaged 25.8 +/- 3.8 and 16.9 +/- 2.8 on postoperative da ys 1 and 3, respectively. Under flurbiprofen therapy (protocol C), the flare amounted to 31.4 +/- 6.6 and 26.2 +/- 3.4 on days 1 and 3, resp ectively. On day 1 postoperatively, there was a significant difference (p < 0.01) between all three treatment protocols. Postoperative fibri n exsudation was observed in 1 of 20 indomethacin and 1 of 20 flurbipr ofen-treated patients (5%), and in 4 of 20 diclofenac-treated patients (20%). The highest individual aqueous humour concentration of indomet hacin was 430 mu g/l, the lowest 30. The concentrations of flurbiprofe n lay between 42 and 31, those of diclofenac between 80 and 30 mu g/l. All patients treated with indomethacin had detectable aqueous humour concentrations, whereas 3 flurbiprofen- and 7 diclofenac-treated patie nts had no HPLC-detectable concentrations (detection limit: 30 mu g/l) . Conclusions After extracapsular cataract surgery, the anti-inflammat ory potency of topical indomethacin 1% is superior to that of flurbipr ofen 0.03% and diclofenac 0.1%, as demonstated by the laser flare-cell meter. The rate of postoperative fibrin exsudation is lower under tre atment with topical indomethacin or flurbiprofen compared to diclofena c. Using the commercially available substances (with different drug co ncentrations and vehicles), indomethacin exhibits a higher aqueous hum our concentration than flurbiprofen, and diclofenac shows the lowest c oncentration.