Efficacy of diclofenac versus dexamethasone for treatment after strabismus surgery

Objective: To compare the efficacy of topical diclofenac sodium 0.1% versus dexamethasone 0.1% on the conjunctival healing process and on intraocular pressure (IOP) after strabismus surgery. Design: A randomized clinical trial. Participants: Forty consecutive pediatric patients who underwent strabismus surgery. Intervention: The patients were assigned before surgery to receive topical diclofenac 0.1% (study group, 20 patients) or dexamethasone 0.1% (control group, 20 patients) from immediately after surgery to up to 4 weeks after surgery (both combined with chloramphenicol 0.2%, polymyxin B sulfate 2500 U). Main Outcome Measures: Between-group comparison of five parameters: patient discomfort, conjunctival chemosis, inflammation, gap, and intraocular pressure (IOP) at 1, 2, and 4 weeks after surgery. Results: At postoperative week 2, the diclofenac-treated group showed significantly less patient discomfort and less conjunctival inflammation, edema, and gap than the dexamethasone group (P = 0.003, P = 0.04, P = 0.02, P = 0.001, respectively). At week 4, the study patients continued to show less discomfort and conjunctival gap (P = 0.02). The dexamethasone group showed a significant change in lOP between the preoperative and the fourth postoperative week (P = 0.001 in the right eye, P = 0.0005 in the left eye) and an increased prevalence of higher IOP during the fourth postoperative week (P = 0.01 in the right eye, P = 0.02 in the left eye). Thirty-eight percent of the dexamethasone group showed an increase in IOP to more than 21 mmHg during the four postoperative weeks. No increase in IOP was noted in the diclofenac group. Conclusions: Topical diclofenac is superior to dexamethasone for each of the five postoperative parameters examined. Its maximal effect occurred at 2 weeks after surgery, without an increase in IOP or in local subconjunctival hemorrhage. (C) 2000 American Academy of Ophthalmology.