The effect of topical diclofenac on choroidal blood flow in early postoperative pseudophakias with regard to cystoid macular edema formation

PURPOSE. To study the chronological change in choroidal blood flow (ChBFlow), disruption of the blood-aqueous barrier, and incidence of cystoid macular edema (CME) in early postoperative pseudophakic eyes, as well as the effect of nonsteroidal anti- inflammatory drug (NSAID) eye drops on these phenomena. METHODS. Fifty patients who underwent phacoemulsification and foldable intraocular lens (IOL) implantation were randomized to receive either topical diclofenac or fluorometholone for 5 postoperative weeks. An additional 20 subjects, with longstanding pseudophakia served as the control. The blood-aqueous barrier was examined by laser flarimetry and choroidal blood velocity (ChBVel), volume (ChBVol), and ChBFlow by laser Doppler flowmetry (LDF) at 2 days and 1, 2, and 5 weeks after surgery. The incidence and severity of CME were evaluated by fluorescein angiography at 2 and 5 weeks after surgery. RESULTS. Compared with patients taking diclofenac, those receiving fluorometholone showed significantly reduced ChBVol at 2 weeks (0.38 +/- 0.08 vs. 0.32 +/- 0.07, P +/- 0.022) and ChBFlow at 1 (11.01 +/- 1.74 vs. 9.35 +/- 1.51, P +/- 0.003) and 2 (11.15 +/- 1.43 vs. 8.47 +/- 1.27, P +/- 0.000) weeks after surgery, as well as a significantly elevated amount of anterior flare at 1 (8.9 +/- 2.2 vs. 24.4 +/- 18.9, P +/- 0.001) and 2 (9.2 +/- 3.5 vs. 16.7 +/- 12.3, P +/- 0.025) weeks after surgery. The ChBVol and ChBFlow in the fluorometholone group, however, returned to normal and was not different from the diclofenac group at 5 weeks after surgery. The incidence of fluorescein angiographic CME trended to be higher (P = 0.08) at 2 weeks and was significantly higher (P = 0.001) at 5 weeks after surgery in eyes with fluoromethalone than with diclofenac. CONCLUSIONS. Reduction of ChBFlow, disruption of the blood aqueous barrier, and incidence of CME in early postsurgical pseudophakic eyes were more effectively prevented chronologically in eyes treated with diclofenac than in those treated with fluorometholone.