[Anti-inflammatory effects and aqueous humor concentration of various nonsteroidal anti-inflammatory drugs in extracapsular cataract surgery].

BACKGROUND

Within the spectrum of anti-inflammatory drugs, the preference of nonsteroidal anti-inflammatory drugs (NSAID) is definitely increasing. In the present study, we compared the anti-inflammatory effects and aqueous humour concentrations of 3 topical NSAID (indomethacin, diclofenac, and flurbiprofen) during extracapsular cataract surgery.

PATIENTS AND METHODS

We examined 90 patients (52-89 yrs of age) without pre-existing deficiencies of the blood-aqueous barrier. In 60 of these patients (series 1), and examination using the laser flare-cell meter was performed prior to and following extracapsular cataract surgery with intraocular lens implantation. In 30 patients (series 2), aqueous humour was drawn intraoperatively, and the NSAID concentration was determined using high-pressure liquid chromatography (HPLC). Patients were randomly assigned to one of the following three treatment protocols with commercially available NSAID: protocol A: indomethacin 1% eyedrops (Chibro-Amuno -3); protocol B: diclofenac 0.1% eyedrops (Voltaren ophtha); protocol C: flurbiprofen 0.03% eyedrops (Ocuflur). 2 drops of either drug were administered as follows: day before surgery (4:00 p.m., late night), day of surgery (2, 1, and 1/2 hrs preop, end of operation, 4:00 p.m., late night), and days 1-3 postoperatively (5 times per day).

RESULTS

Under indomethacin therapy (protocol A), the flare [in photon counts/ms] increased from a preoperative value of 8.0 +/- 2.8 (means +/- SE) to 20.1 +/- 2.2 on day 1 postoperatively, and decreased to 16.9 +/- 2.5 on day 3. Under diclofenac therapy (protocol 2), the flare averaged 25.8 +/- 3.8 and 16.9 +/- 2.8 on postoperative days 1 and 3, respectively. Under flurbiprofen therapy (protocol C), the flare amounted to 31.4 +/- 6.6 and 26.2 +/- 3.4 on days 1 and 3, respectively. On day 1 postoperatively, there was a significant difference (p < 0.01) between all three treatment protocols. Postoperative fibrin exsudation was observed in 1 of 20 indomethacin- and 1 of 20 flurbiprofen-treated patients (5%), and in 4 of 20 diclofenac-treated patients (20%). The highest individual aqueous humour concentration of indomethacin was 430 micrograms/1, the lowest 30. The concentrations of flurbiprofen lay between 42 and 31, those of diclofenac between 80 and 30 micrograms/1. All patients treated with indomethacin had detectable aqueous humour concentrations, whereas 3 flurbiprofen- and 7 diclofenac-treated patients had no HPLC-detectable concentrations (detection limit: 30 micrograms/1).

CONCLUSIONS

After extracapsular cataract surgery, the anti-inflammatory potency of topical indomethacin 1% is superior to that of flurbiprofen 0.03% and diclofenac 0.1%, as demonstrated by the laser flare-cell meter. The rate of postoperative fibrin exsudation is lower under treatment with topical indomethacin or flurbiprofen compared to diclofenac. Using the commercially available substances (with different drug concentrations and vehicles), indomethacin exhibits a higher aqueous humour concentration than flurbiprofen, and diclofenac shows the lowest concentration.