Comparison of diclofenac and fluorometholone in preventing cystoid macularedema after small incision cataract surgery: A multicentered prospective trial

Purpose: To compare a nonsteroidal topical solution (0.1% diclofenac) to a steroidal topical solution (0.1% fluorometholone) in preventing cystoid mac ular 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 acryl ic intraocular lens by the envelope technique. The presence and degree of c ystoid macula edema (CME) was determined by fluorescein angiography. A brea kdown of the blood-aqueous barrier was determined by laser flare-cell photo metry. Results: Five weeks after surgery, CME was present in 3 of 53 eyes (5.7%) r eceiving di clofenac and in 29 of 53 eyes (54.7%) receiving fluorometholone . This difference was statistically significant (P < .001). The amount of f lare 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. Th e degree of flare at 3 days, 1, 2, 5 and 8 weeks after surgery was signific antly higher in eyes with CME (P < .001). Conclusions: These findings suggest that diclofenac effectively prevents CM E following cataract surgery and that CME is closely related to the breakdo wn of the blood-aqueous barrier. (C) 2000 Japanese Ophthalmological Society .