Incidence of postoperative posterior capsular opacification following treatment with diclofenac 0.1% and ketorolac 0.5% ophthalmic solutions: 3-year randomized, double-masked, prospective clinical investigation.

PURPOSE: Laboratory studies in experimental animals suggest that use of nonsteroidal anti-inflammatory drugs decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. Recently the incidence of PCO following cataract surgery and intraocular lens implantation was reported to be no different following postoperative treatment with diclofenac sodium 0.1% (Voltaren, Ciba Vision) or with dexamethasone 0.1% (Maxidex, Alcon). We studied the incidence of PCO in patients following treatment with diclofenac 0.1% and ketorolac tromethamine 0.5% (Acular, Allergan) ophthalmic solutions 3 years after cataract surgery and implantation of a foldable silicone intraocular lens. METHODS: A total of 120 patients underwent phacoemulsification and implantation of a foldable silicone intracular lens. Patients were treated with either diclofenac 0.1% ophthalmic solution or 0.5% ketorolac ophthalmic solution 4 times daily for 30 days in a double-masked, randomized fashion during the postoperative period. Patients were examined 3 years following surgery by a masked observer who determined which patients received YAG capsulotomies and graded any existing PCO. RESULTS: Each treatment group had 12% YAG capsulotomies 3 years following surgery. Although PCO was present more often with diclofenac treatment (25/62) than with ketorolac treatment (16/58), this difference is not statistically significant (P = .142). Patients tolerated both treatments well without a difference in toxic effects or tolerability. CONCLUSIONS: This study did not demonstrate a difference in the ability of diclofenac or ketorolac ophthalmic solutions to prevent PCO following cataract extraction and implantation of an intraocular lens. Both treatment regimens were equally well tolerated.

Comparative effects of ketorolac 0.5% or diclofenac 0.1% ophthalmic solutions on inflammation after cataract surgery.

OBJECTIVE: Ketorolac tromethamine 0.5% and diclofenac sodium 0.1% ophthalmic solutions are approved for use by the U.S. Food and Drug Administration to avoid excessive postoperative inflammation after cataract surgery and implantation of an intraocular lens. This study compares the efficacy and toxicity of these nonsteroidal anti-inflammatory drugs for the first time. DESIGN: Randomized, double-masked, prospective clinical trial. PARTICIPANTS: A total of 120 patients assigned in equal numbers to 1 of the 2 treatment regimens. INTERVENTION: Treatment with either ketorolac 0.5% or diclofenac 0.1% ophthalmic solutions instilled four times daily for 30 days beginning the first postoperative day after surgery. MAIN OUTCOME MEASURES: Objective (Kowa FC 1000 laser cell and flare meter) and subjective (slit-lamp biomicroscope) measurements of inflammation and toxicity were made and compared at three separate post-operative visits. RESULTS: The anti-inflammatory effects of the two treatment regimens were not statistically different at any of the postoperative visits. Patients tolerated both treatments equally well. CONCLUSIONS: This study shows diclofenac sodium 0.1% and ketorolac tromethamine 0.5% ophthalmic solutions are equally effective and safe for the control of postoperative inflammation after uncomplicated cataract surgery performed by phacoemulsification followed by the implantation of a foldable intraocular lens.

Choroidal neovascularization not associated with age-related macular degeneration.

Choroidal neovascularization (CNV) is an important clinical finding that is associated with many ocular conditions, including inflammatory, infectious, degenerative, hereditary, and congenital disorders, ocular tumors, trauma, and a few miscellaneous disorders. The growth of new choroidal vessels beneath the retinal pigment epithelium is associated with specific clinical signs. The clinical recognition of CNV plays a key role in the prognosis and management of these disorders. The clinical presentation of each disorder associated with CNV is reviewed in this paper, with comments on the location and the frequency of CNV occurrence.

Traumatic retinal detachment.

Ocular contusion may result in numerous types of retinal breaks, including horseshoe tears, operculated holes, large irregular retinal breaks, macular holes, and, most often, retinal dialyses. Supranasal dialyses have a high correlation with trauma and may require months before symptoms appear. Large irregular breaks occur only following trauma and may be found in the area of contusion. Horseshoe-shaped tears and operculated holes may occur at areas of vitreoretinal attachment. Macular holes may also occur from trauma, either from detachment of vitreous or as a sequela of retinal edema. Careful examination of the posterior pole and retinal periphery is necessary when there is a history of trauma or findings indicative of a past episode of trauma. Binocular assessment of the retina is a prerequisite to conducting an appropriate examination.

Progression of amiodarone induced cataracts.

Amiodarone hydrochloride is a potent antiarrhythmic agent recently approved for use by the Food and Drug Administration. Anterior subcapsular lens opacities were observed in seven of fourteen patients treated with moderate to high doses of amiodarone at the Veterans Administration Medical Center in San Francisco in 1982. The present report summarizes the present status of these same fourteen patients ten years later. Anterior subcapsular lens opacities developed or progressed in all patients continuing treatment with this antiarrhythmic agent during the following ten year interval. Although Snellen visual acuities are not decreased, subtle visual impairment is present as measured by contrast sensitivity measurements with and without glare. This decrease in visual acuity is not a contraindication for therapy with this potentially life saving drug.

Effectiveness of ketorolac tromethamine 0.5% ophthalmic solution for chronic aphakic and pseudophakic cystoid macular edema.

The effect of ketorolac tromethamine 0.5% ophthalmic solution (a new nonsteroidal anti-inflammatory agent) treatment was compared to placebo treatment in patients with chronic, angiographically proven aphakic or pseudophakic cystoid macular edema (visual acuity less than or equal to 20/40 for six months) during a three- to four-month double-masked, randomized study. Twenty-six patients completed this study without significant ocular or systemic toxicity. The improved distance visual acuity observed in the ketorolac treatment group (8/13 patients) was statistically different from the improved vision observed in the placebo treated group (1/13 patients) (P = .005). No patient on a regimen of ketorolac therapy had a significant decrease in Snellen distance visual acuity while on treatment, but two patients in the placebo group demonstrated a decrease in visual acuity of two lines or more. Fluorescein angiography was consistent with changes in visual acuity.

Amiodarone keratopathy and lens opacities.

Amiodarone hydrochloride is an antiarrhythmic drug which produces a keratopathy and anterior subcapsular lens opacities that are usually asymptomatic. Serial observations for eye findings were made in 21 patients on a daily dosage of 200-600 mg for periods ranging from six months to three years. Corneal deposits developed in all 21 patients and anterior lens opacities developed in 12 of 20 phakic patients. Resolving keratopathy was present in three patients for periods of at least seven to 20 months after amiodarone was discontinued.

Anterior subcapsular cataracts: a review of potential etiologies.

Photographs of amiodarone-induced anterior subcapsular lens opacities and axial punctate lens opacities are presented and compared for the first time. The similarities and differences between these lens opacities and phenothiazine-induced lens opacities are discussed. Potential etiologies for anterior subcapsular cataracts are reviewed. The biomicroscopic techniques required to appreciate subtle lens opacities are mentioned. The importance of recognizing and recording subtle lens opacities is discussed.

The therapy of Adie's syndrome with dilute pilocarpine hydrochloride solutions.

Impressed by the benefit two patients with Adie's Syndrome derived from topical 0.1% pilocarpine therapy, we performed the present study to examine the measurable effects of 0.1% pilocarpine in several patients with this syndrome. Our study suggests those patients with Adie's Syndrome who lack stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity improves following a single drop of 0.1% pilocarpine. Therefore, we recommend measuring stereoacuity during pupil diagnostic testing with 0.1% pilocarpine hydrochloride. Potential problems concerning medical therapy of Adie's Syndrome with parasympathomimetics are discussed.

Adie's syndrome: a medical treatment for symptomatic patients.

A symptomatic patient with Adie's syndrome is described as successfully managed with pilocarpine 0.125% applied topically to the involved eye three times daily. This is the first report of such a patient responding to direct parasympathomimetic therapy. Alternate approaches to the therapy of Adie's syndrome are mentioned. An approach to the management of Adie's syndrome is proposed.

Amiodarone-induced lens opacities.

Amiodarone hydrochloride is a benzofurane derivative used for cardiac abnormalities. Its use is commonly associated with an asymptomatic keratopathy. Although lipid deposits have been observed with the electron microscope in the lens epithelium of one patient with a history of amiodarone therapy, lens opacities have not been reported in patients using this drug. Visually inconsequential, anterior subcapsular lens opacities in seven of 14 patients using moderate to high doses of amiodarone who were examined at the Veterans Administration Hospital in San Francisco are reviewed.