Diclofenac vs indomethacin in reducing postoperative inflammation : a randomized clinical trial

Purpose. To compare the efficacy and tolerability of diclofenac vs indomethacin eyedrops in reducing postoperative inflammation after phaco-extraction and IOL implantation. Methods. 100 patients undergoing phaco through a standard corneal tunnel procedure: 50 were given diclofenac 0.1% eyedrops, while 50 received indomethacin 0.1% eyedrops and were examined 1, 7 and 14 days after surgery. Postop inflammation was graded according to a dedicated scoring system that included evaluation of conjunctival hyperaemia, flare and cells count in the anterior chamber, corneal edema, and ciliary flush. Burning, stinging and blurred vision symptoms at drops instillation were recorded through a questionnaire. Other variables such as IOP, occurrence of surgical complications, duration of surgery, duration and intensity of phaco ultrasounds that might be related to study outcomes were also recorded. Results. Mean inflammatory scores were 4.00 (sd=1.05) and 5.32 (sd=1.64) at day 1, 1.14 (sd=0.45) and 1.61 (sd=0.51) at day 7, and 0.29 (sd=0.16) and 0.33 (sd=0.18) at day 14 for diclofenac and indomethacin respectively. After adjusting for factors related to surgery (i.e. duration of phacoemulsification, duration and intensity of ultrasounds, type of IOL, postop IOP etc.) the difference between the two groups failed to reach statistical significance. Tolerability was good both for diclofenac and indomethacin and no significant difference arised. Conclusions. Diclofenac and indomethacin seem to be both effective in reducing postop inflammation and provide a safe alternative to steroids for the management of the patients undergoing phacoemulsification.