Abstract
Purpose: To determine whether the use of topical diclofenac sodium (diclofenac) pre-operatively improves the maintenance of per-operative mydriasis, in conjunction with irrigating solutions containing adrenaline.
Methods: Sixty-four consecutive patients undergoing phacoemulsification were randomised to receive either diclofenac or no diclofenac in conjunction with cyclo-pentolate 1% and phenylephrine 10% pre-operatively. They subsequently underwent routine phacoemulsification by one consultant surgeon. Irrigating solutions of balanced salt solution contained adrenaline 1:106. Pupil diameters were measured pre-sclerostomy, post-phacoemulsification, post-irrigation/aspiration and on day 1 post-operatively. These were then compared by Student's t-test.
Results: The two groups were statistically similar in age and sex. The mean pre-sclerostomy pupillary diameters were 8.1 mm in both groups. The mean post-phaco-emulsification diameters were 7.6 mm in those receiving diclofenac and 7.2 mm in those not (p = 0.03). The mean diameters after infusion/aspiration were 7.7 mm in those receiving diclofenac and 7.1 mm in those not (p = 0.008). The mean pupillary diameters on day 1 were 5.3 mm in those receiving diclofenac and 4.6 mm in those not (p = 0.003).
Conclusion: Diclofenac improves the maintenance of per-operative mydriasis, in the presence of irrigating solutions containing adrenaline.
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Corbett MC, Richards AB . Intraocular adrenaline maintains mydriasis during cataract surgery. Br J Ophthalmol 1994;78:95–8.
Goa KL, Chrisp P . Ocular diclofenac: a review of its pharmacology and clinical use in cataract surgery, and potential in other inflammatory ocular conditions. Drugs Ageing 1992;2:473–86.
Araie M, Sawa M, Takase M . Topical flurbiprofen and diclofenac suppress blood-aqueous barrier breakdown in cataract surgery: a fluorophotometric study. Jpn J Ophthalmol 1983;27:535–42.
Bonomi L, Perfetti S, Bellucci R, Massa F, De Franco I . Prevention of surgically induced miosis by diclofenac eye drops. Ann Ophthalmol 1987;19:142–5.
Fabian E, von Denffer H, Wertheimer R . Diclofenac eye drops to maintain mydriasis during extracapsular cataract extraction. Ophthalmo-Chirurgie 1991;3:115–9.
Erturk H, Ozcetin H, Avci R . Diclofenac sodium for the prevention of surgically-induced miosis. Eur J Implant Refract Surg 1991;3:55–7.
Dimitrakos SA, Topouzidis C, Panidou-Kyriakidou I . Prevention du myosis peroperatoire: comparison des inhibitors de prostaglandins. Diclophenac sodium et indomethacine en application locale. J Fr Ophtalmol 1992;15:5–8.
Bonomi L, Totolo G, Marchini G, Rigotti P, Ghini M . Prevention of trauma-induced miosis during cataract surgery by diclofenac eye drops. New Trends Ophthalmol 1987;2:513–9.
Psilas K, Kalogeropoulos C, Loucatzicos E, Aspoudis I, Petroutsos G . The effect of indomethacin, diclofenac and flurbiprofen on the maintenance of mydriasis during extracapsular cataract extraction. Doc Ophthalmol 1992;81:293–300.
Quentin CD, Behrens-Baumann W, Gaus W . Prophylaxe des zystoiden Makulodems mit Diclofenac-Augentrofen bei i.c. Kataraktextraktion mit Choyce-Mark-IX-Vorderkammerlinse. Fortschr Ophthalmol 1989;86:546–9.
Roberts CW, Brennan KM . A comparison of topical diclofenac with prednisolone for post-cataract inflammation. Arch Ophthalmol 1995;113:725–7.
Othenin-Girard P, Tritten JJ, Pittet N, Herbort CP . Dexamethasone versus diclofenac sodium eyedrops to treat inflammation after cataract surgery. J Cataract-Refract Surg 1994;20:9–12.
Strelow SA, Sherwood MB, Broncato LJB, Napier A, Driebe WT, Guy JR, Vickers FF, Mellars K . The effect of diclofenac sodium ophthalmic solution on intraocular pressure following cataract extraction. Ophthalmic Surg 1992;23:170–5.
Kraff MC, Martin RG, Neumann AC, Weinstein AJ . Efficacy of diclofenac sodium ophthalmic solution versus placebo in reducing inflammation following cataract extraction and posterior chamber lens implantation. J Cataract Refract Surg 1994;20:138–44.
Flower R . Glucocorticoids, phospholipase A2 and inflammation. Pharmacol Sci 1981:2:186–9.
Miyake K, Sugiyama S, Norimatsu I, Ozawa T . Prevention of cystoid macular oedema after lens extraction by topical indomethacin. III. Radioimmu-noassay measurements of prostaglandins in the aqueous during and after lens extraction procedures. Graefes Arch Klin Exp Ophthalmol 1978;209:83–8.
Sawa M, Araie M, Tanishima T . Fluorophotometric study of the barrier functions in the anterior segment of the eye after intracapsular cataract surgery. Jpn J Ophthalmol 1983;27:404–15.
Soloway MR, Stjernschantz J, Saers M . The miotic effect of substance P on the isolated rabbit iris. Invest Ophthalmol Vis Sci 1981;20:46–52.
Uddman R, Alumets J, Ehringer B, Hakenson R, Loren I, Sundler F . Vasoactive intestinal peptide nerves in ocular and orbital structures of the cat. Invest Ophthalmol Vis Sci 1980;19:878–85.
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