Steroidal and nonsteroidal anti-inflammatory agents. Effect on postsurgical inflammation and blood-aqueous humor barrier breakdown

Abstract

Two hundred and eighty-three patients scheduled to undergo extracapsular cataract extraction with intraocular lens implantation were randomized into four treatment groups that received 1% topical indomethacin and 0.1% topical dexamethasone sodium phosphate, either drug and the other drug's placebo, or two placebos. Inflammation was assessed by clinical grading, and the breakdown of the blood-aqueous barrier was evaluated by slit-lamp anterior segment fluorophotometry. Patients who used either or both anti-inflammatory agents had significantly less inflammation or blood-aqueous barrier breakdown than did those who used neither agent. Also, the use of both topical indomethacin and dexamethasone resulted in less fluorescein leakage during the second postoperative week than did the use of dexamethasone alone. Since this difference could not be detected by clinical measurement, we believe that fluorophotometry is a more sensitive quantitative measure. Clinical assessment of inflammation did correlate with fluorophotometric measurements, as patients with clinically unacceptable inflammation had 3.7 times more fluorescein leakage in the surgically treated eye than did patients with clinically acceptable inflammation.