[Anti-inflammatory effect of a local combination therapy with diclofenac and prednisolone vs. indomethacin and prednisolone. A laser flare cell photometry study]

Author(s): Hessemer V, Schmitt K

Affiliation(s): Universitats-Augenklinik Giessen.

Publication date & source: 1994-04, Ophthalmologe., 91(2):224-8.

Publication type: Clinical Trial; Randomized Controlled Trial

The nonsteroidal anti-inflammatory agent diclofenac (Voltaren) has recently become commercially available in form of 0.1% eyedrops (Voltaren ophtha). In the present study, we compared the anti-inflammatory effect of a topical combination therapy with diclofenac and prednisolone vs. indomethacin and prednisolone. PATIENTS AND METHOD: The FC-1000 laser flare-cell photometer (Kowa) was used to investigate 40 patients before and after cataract surgery with IOL implantation. This method allows quantitative in vivo determination of aqueous flare and aqueous particle concentration. The patients were randomly assigned to one of the following two treatment protocols: Protocol A: diclofenac 0.1% eyedrops and prednisolone 1% eyedrops (Inflanefran forte); protocol B: indomethacin 1% eyedrops (Chibro-Amuno 3) and prednisolone 1% eyedrops. One drop of either drug was administered 4 times per day to each patient. Treatment with nonsteroidal agents started on the day before surgery, whereas prednisolone treatment started immediately at the end of surgery. No parabulbar or oral steroids were administered. RESULTS: In group A (diclofenac and prednisolone), the flare (in photon counts/ms) increased from a preoperative value of 10 +/- 4.3 (mean +/- SD) to 36.7 +/- 19.3 on the 1st postoperative day. This value is significantly (P < 0.05) higher than in group B (indomethacin and prednisolone) on the 1st postoperative day: 27.4 +/- 9.4. The aqueous particle concentration on day 1 after surgery was also significantly (P < 0.01) higher under treatment with diclofenac and prednisolone than with indomethacin and prednisolone (44.3 vs 26.3 particles/0.075 mm3, respectively). On the 3rd postoperative day, the differences between the two treatment groups were no longer present. CONCLUSIONS: In the early postoperative period after cataract surgery, the anti-inflammatory effect of a topical combination therapy with diclofenac and prednisolone is weaker than that of indomethacin and prednisolone. However, this difference is no longer observed on day 3 after surgery, so that there is probably no major difference in clinical outcome between the two treatment protocols.