The effect of topical sodium diclofenac treatment on macular thickness post phacoemulsification in d

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The effect of topical sodium diclofenac treatment
on macular thickness post phacoemulsification in
diabetic and non diabetic patients

• Shula Schwartz, Nathanael BenHamou, Noa Chetrit,
  Isaac Avni, David Zadok
• DEPARTEMENT OF OPHTHALMOLOGY, ASSAF HAROFEH
  MEDICAL CENTER, ZERIFIN, ISRAEL
• The authors have no financial or proprietary
  interest in any material or method mentioned in
  this manuscript

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Purpose

• To investigate the influence of uneventful phaco
  surgery on macular thickness of DM and non- DM
  patients.
• To investigate the role of NSAIDS eye drops (
  Voltaren, sodium diclofenac 0.1) in modifying
  the macular thickness.
• Prospective, randomized, clinical trial

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Methods

• All patients underwent a standard phaco procedure
  with PC IOL implantation.
• Uneventful cataract surgery-96.
• Patients were divided into two groups of post
  operative treatments (groups A B)
• Steroid eye drops 4 times a day for 4 weeks.
• Voltaren and steroids eye drops 4 times a day for
  4 weeks.
• Each group was further divided into two groups
  (groups 12 ).
• 1. Non DM patients.
• 2. DM patients.

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Patients groups
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Methods

• Exclusion criteria
• Advanced cataract, Glaucoma, High myopia (gt 7 D),
  uveitis and AMD.
• Diabetic patients characteristics
• Adult type.
• Diabetic retinopathy none to moderate.
• No pre existing macular edema.
• Data gathering included
• Age, gender, background diseases, technical data
  and complications during operation.
• For diabetics blood pressure measurements,
  retinopathy staging, duration of diabetes and
  mode of treatment.

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Methods

• Follow up
• Preoperative.
• 1 week, 1, 3, 6 months post operatively.
• Measurements included
• BCVA - Snellen chart.
• Macular thickness using stratus OCT3.
• macular mapping software using fast macular and
  regular six radial scans centered on the fixation
  point (automatically calculated).
• mean thickness in the central 1000µm diameter
  area.
• Reliable (sensitivity specificity gt 90).
• Excellent reproducibility (11µm).

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Macular thickness- normal Values
239 16
Fovea ( 1000 µm) 212 20 µm
255 17
26713
246 14
251 13
21014
Temporal
Nasal
260 15
Central fovea 182 23 µm
210 13
Chan A, Schuman JS .Normal macular thickness
measurements in healthy eyes using Stratus
optical coherence tomography. Arch Ophthalmol.
2006.
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Results- 1 month post op
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Results- 1 month post op

• No correlation was found between macular
  thickness changes post operatively and diabetes.
• No correlation was found between macular
  thickness changes post operatively and the use of
  Voltaren prophylactically after surgery.
• A weak negative correlation was found between
  BCVA and macular thickness changes
  postoperatively (r -0.18, P 0.16).

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Results

• Time trend assessment over 6 months period post
  operatively.

Macular thickness
BCVA
lt.0001 0.5754 0.0577 0.093
5 0.0115 0.3568
time
0.0007 diabetes
0.6029 timediabetes
0.2871 voltaren
0.1103 timevoltaren
0.4971 diabetesvoltaren 0.9475
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Results

• Risk factors assessment
• HTN,Diabetes duration - no
• Retinopathy stage
• 69.4 had no retinopathy.
• Borderline correlation with macular thickness
  (p0.0586).

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Results

• 1 patient (group 1B) developed CME after a month
  1.3 (1/75)
• Macular thickness- 475 µm
• Resolved in two months
• Diabetic patients did not develop clinical
  macular edema.

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Conclusions

• Sub-clinical macular thickness changes can be
  noted after an uneventful phaco surgery in DM and
  non-DM patients using the OCT.
• OCT is a sensitive tool for detecting and
  measuring early macular thickening.
• Very low incidence of pseudophakic CME was found
  after an uneventful phaco procedures (1.3).

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Conclusions

• Diabetic patients with none to moderate
  retinopathy, without pre-existing macular edema
  do well after uneventful phaco procedure.
• Voltaren doesn't have a statistically significant
  influence on the postoperative macular thickness
  changes both in diabetic and non diabetic
  patients.

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Thank you