School of Medicine, University of Leeds, Leeds, United Kingdom.
School of Medical Sciences, University of Manchester, Manchester, United Kingdom.
J Ocul Pharmacol Ther. 2021 Jul-Aug;37(6):343-353. doi: 10.1089/jop.2020.0133. Epub 2021 Apr 30.
To compare outcomes of diclofenac versus dexamethasone in patients after strabismus surgery. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted on MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). All randomized controlled trials (RCTs) comparing the outcomes of diclofenac versus dexamethasone poststrabismus surgery were included. An extraction spreadsheet for data collection and Review Manager 5.3 were used for data analysis based on the fixed and random effects models. Discomfort, inflammation, chemosis, conjunctival gap, and intraocular pressure (IOP) were primary outcome measures. Secondary outcomes included conjunctival congestion and injection, discharge, and drop intolerance. Fixed and random effects models were used for the analysis. Five RCTs enrolling 248 subjects were enrolled. At week 2 postoperatively, there was a significant difference favoring diclofenac over dexamethasone in terms of discomfort (mean difference [MD] = -0.37, = 0.02), conjunctival inflammation (MD = -0.16, = 0.02), conjunctival chemosis (MD = -0.16, = 0.04), and postoperative conjunctival gap (MD = -0.17, = 0.002). In terms of IOP, there were no significant differences. However, no statistically significant differences were noted at weeks 1 and 4 postoperatively. For secondary outcomes, dexamethasone had significantly improved conjunctival congestion; however, diclofenac had significantly less injection at the site of muscle attachments at week 2. No significant difference was noted in terms of discharge and drop intolerance. Diclofenac is comparable to dexamethasone when used following strabismus surgery. However, a significant difference favoring diclofenac in terms of discomfort, inflammation, conjunctival chemosis, and conjunctival gap was only noted at 2 weeks postoperatively. The authors suggest conducting further studies to support the effectiveness of diclofenac as an alternative to corticosteroids following strabismus surgery.
比较斜视手术后使用双氯芬酸和地塞米松的患者结局。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统评价和荟萃分析。在 MEDLINE、EMBASE、EMCARE、CINAHL 和 Cochrane 对照试验中心注册库（CENTRAL）上进行了搜索。纳入了比较斜视手术后双氯芬酸与地塞米松结局的随机对照试验（RCT）。使用数据收集提取表和 Review Manager 5.3 基于固定效应模型和随机效应模型进行数据分析。不适、炎症、水肿、结膜间隙和眼内压（IOP）是主要结局指标。次要结局包括结膜充血和注射、分泌物和滴注不耐受。分析采用固定和随机效应模型。纳入了 5 项 RCT，共 248 例受试者。术后 2 周时，双氯芬酸在不适（平均差异 [MD] = -0.37， = 0.02）、结膜炎症（MD = -0.16， = 0.02）、结膜水肿（MD = -0.16， = 0.04）和术后结膜间隙（MD = -0.17， = 0.002）方面明显优于地塞米松。在 IOP 方面，差异无统计学意义。然而，术后 1 周和 4 周时均未观察到统计学差异。对于次要结局，地塞米松显著改善了结膜充血；然而，双氯芬酸在肌肉附着部位的注射显著较少，差异有统计学意义。在分泌物和滴注不耐受方面无显著差异。双氯芬酸与地塞米松在斜视手术后使用时效果相当。然而，只有在术后 2 周时，双氯芬酸在不适、炎症、结膜水肿和结膜间隙方面才具有明显的优势。作者建议进行进一步的研究，以支持双氯芬酸作为斜视手术后替代皮质类固醇的有效性。
