The effect of topical diclofenac on the incidence of macular edema and intraocular inflammatory reaction in patients with diabetic retinopathy after phacoemulsification cataract surgery

Abstract

Dosadašnje studije su pokazale da je incidencija makularnog edema značajno viša nakon operacije mrene, osobito kod bolesnika s dijabetičnom retinopatijom kod kojih je prisutna kronična subklinička upala. Ovo istraživanje je pokazalo da preoperativna terapija topičkim nesterodnim protu-upalnim lijekovima (NSAID) može smanjiti incidenciju pojave postoperativnog makularnog edema i progresiju dijabetične retinopatije. Metode: U studiju je bilo uključeno 55 bolesnika s neproliferativnom dijabetičnom retinopatijom koji su predviđeni za operaciju mrene. Jednostavnom kompjuterskom randomizacijom bolesnici podijeljeni u dvije skupine: 27 bolesnika u eksperimentalnoj skupini tretirano je preoperativno i postoprativno topičkim diklofenakom, a 28 bolesnika u kontrolnoj skupini dobilo je placebo. Sedam dana prije operacije, na dan operacije i 1., 7., 30. i 90. dan postoperativno centralna makularna debljina (CFT) mjerena je optičkom koherentnom tomografijom (OCT), a prije same operacije uzimao se uzorak očne vodice za analizu koncentracije IL-12. Rezultati: Koncentracija IL-12 bila je značajno manja u eksperimentalnoj skupini u odnosu na kontrolnu skupinu (t = −2.85, P = 0.007). Eksperimentalna skupina imala je značajno manji porast centralne makularne debljine nakon operacije mrene od kontrolne skupine (F = 13.57, P < 0.05). Značajno viša incidencija pogoršanja stupnja dijabetične retinopatije pronađena je u 11 (39, 28 %) pacijenata kontrolne skupine, dok je u eksperimentalnoj skupini pogoršanje zabilježeno kod 5 (19.23 %) pacijenata (χ2 = 13.18, P < 0.001). Zaključak: Preoperativna i postoperativna terapija topičkim NSAIDs može adekvatno prevenirati razvoj postoperativnog makularnog edema kod pacijenata s dijabetičnom retinopatijom te bi mogla prevenirati progresiju DR kod nekih pacijenata vjerojatno utjecajem na nivo preoperativne subkliničke upale prisutne kod pacijenata sa DR-om. Subklinička upala prisutna u pacijenata s DR-om, a mjerene koncentracijom IL-12, nije jedini uzrok makularnog edema.Previous studies have shown that macular edema is more frequent after cataract surgery, especially in patients with diabetic retinopathy who present with subclinical preoperative inflammation. This study aimed to investigate if preoperative treatment with a topical nonsteroid antiinflammatory drug (NSAID) may lower the incidence of postoperative macular edema and progression of diabetic retinopathy. Methods: A total of 55 patients with nonproliferative diabetic retinopathy who required cataract surgery were divided into two groups; 27 patients who were treated preoperatively and postoperatively with topical diclofenac, and 28 patients who received placebo. Seven days prior to surgery, on the day of surgery, and 1, 7, 30, and 90 days postoperatively, central foveal thickness (CFT) was measured with optical coherence tomography (OCT), and the aqueous humor was sampled at the beginning of cataract surgery for the analysis of IL-12 concentration. Results: The aqueous humor IL-12 concentration was significantly lower in the experimental group than in the control group (t = −2.85, P = 0.007), and the experimental group had a significantly smaller increase in CFT after phacoemulsification than the control group (F = 13.57, P < 0.05) .A significantly higher incidence of postoperative worsening of the grade of diabetic retinopathy was registered in 11 (39,28%) patients in the control group compared to 5 (19.23%) patients in the experimental group (χ2 = 13.18, P < 0.001). Conclusion: Patients preoperatively treated with diclofenac had significantly lower intraocular levels of IL-12 and a lower increase in CFT, which indicates that a combination of preoperative and postoperative treatment with a topical NSAID may lower the incidence of postoperative macular edema in patients with diabetic retinopathy