Efficacy of diclofenac versus dexamethasone for treatment after strabismussurgery

Objectives To compare the efficacy of topical diclofenac sodium 0.1% versus dexamethasone 0.1% on the conjunctival healing process and on intraocular pressure (IOP) after strabismus surgery. Design: A randomized clinical trial. Participants: forty consecutive pediatric patients who underwent strabismus surgery. Intervention: The patients were assigned before surgery to receive topical diclofenac 0.1% (study group, 20 patients) or dexamethasone 0.1% (control g roup, 20 patients) from immediately after surgery to up to 4 weeks after su rgery (both combined with chloramphenicol 0.2%, polymyxin B sulfate 2500 U) . Main Outcome Measures: Between-group comparison of five parameters: patient discomfort, conjunctival chemosis, inflammation, gap, and intraocular pres sure (IOP) at 1, 2, and 4 weeks after surgery. Results: At postoperative week 2, the diclofenac-treated group showed signi ficantly less patient discomfort and less conjunctival inflammation, edema, and gap than the dexamethasone group (P = 0.003, P = 0.04, P = 0.02, P = 0 .001, respectively). At week 4, the study patients continued to show less d iscomfort and conjunctival gap (P = 0.02). The dexamethasone group showed a significant change in IOP between the preoperative and the fourth postoper ative week (P = 0.001 in the right eye, P = 0.0005 in the left eye) and an increased prevalence of higher IOP during the fourth postoperative week (P = 0.01 in the right eye, P = 0.02 in the left eye). Thirty-eight percent of the dexamethasone group showed an increase in IOP to more than 21 mmHg dur ing the four postoperative weeks. No increase in IOP was noted in the diclo fenac group. Conclusions Topical diclofenac is superior to dexamethasone for each of the five postoperative parameters examined. Its maximal effect occurred at 2 w eeks after surgery, without an increase in IOP or in local subconjunctival hemorrhage. Ophthalmology 2000;107:1884-1888 (C) 2000 by the American Acade my of Ophthalmology.