The effect of pre-operative topical flurbiprofen or diclofenac on pupil dilatation

Purpose To assess the clinical benefit and relative efficacy of pre-operati ve diclofenac and flurbiprofen drops in routine cataract surgery. Methods Fifty-two patients undergoing extracapsular cataract extraction wit h lens implantation were randomised in a double-masked study to compare the efficacy of diclofenac, flurbiprofen and placebo drops in maintaining per- operative mydriasis and reducing post-operative inflammation. Balanced salt solution containing adrenaline was used in all patients. Pupil size was me asured prior to the corneal section and after the completion of the operati on. The degree of pain, redness, flare and cells in the anterior chamber an d intraocular pressure were recorded on the day after surgery. The three gr oups were analysed with respect to change in pupil size, intraocular pressu re and degree of inflammation. Results The change in pupil size was significantly different among the thre e groups (p = 0.01), there being a smaller decrease in the treatment groups compared with the placebo group and in the diclofenac treatment group comp ared with the flurbiprofen treatment group. Significantly less post-operati ve redness was recorded in the diclofenac treatment group compared with the other groups (p = 0.001). No significant difference was found between the groups as regards anterior chamber cells, flare or intraocular pressure cha nge. Conclusions Pre-operative diclofenac and flurbiprofen drops are effective i n maintaining intraoperative mydriasis. Diclofenac reduces post-operative r edness on day 1. These effects are of debatable clinical benefit.