Reducing angiographic cystoid macular edema and blood–aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation : Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethaso

PurposeTo compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood–aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation.SettingsShohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan.MethodsThis multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood–aqueous barrier disruption was determined by laser flare–cell photometry.ResultsOf the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003).ConclusionsDiclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.