Diclofenac sodium and nuclear rotation may prevent PCO after hydrodissection

This study evaluated the effect of combined diclofenac sodium and nuclear rotation on the prevention of posterior capsule opacification (PCO) in both animal eyes and cataract patients. The authors found that lens epithelial cell (LEC) coverage time was significantly longer in porcine eyes that underwent hydrodissection with diclofenac sodium or with combined diclofenac sodium and nuclear rotation compared with control eyes. Additionally, the degree of PCO was significantly less through the two-year follow-up period among patients randomized to hydrodissection performed with diclofenac sodium or with combined diclofenac sodium and nuclear rotation.

The study randomized one eye of 30 pairs of porcine eyes to hydrodissection with diclofenac sodium, with 0.25 mg/mL diclofenac sodium and nuclear rotation, or with controls of saline or lidocaine. The latter group was considered a control because of the lidocaine component in the diclofenac sodium. Primary cells of porcine lens epithelium from the posterior lens capsule were obtained in each group. Proliferation and coverage time for LECs were noted. In the clinical study, 72 patients with age-related cataract (80 eyes) were randomized to undergo hydrodissection with a balanced salt solution, with lidocaine, with 0.25 mg/mL diclofenac sodium or with 0.25 mg/mL combined diclofenac sodium and nuclear rotation.

There were no significant differences between the four groups in the clinical study in corrected distance visual acuity or corneal endothelial cell density during follow-up (P > 0.05). However, PCO scores in the groups treated with diclofenac sodium or combined diclofenac sodium and nuclear rotation were significantly lower than in the other two groups (P < 0.001), with the lowest PCO score in the combined diclofenac sodium and nuclear rotation group.

In our lab, we are currently investigating different solutions that can be used to irrigate the capsular bag during hydrodissection or after evacuation to prevent overall capsular bag opacification. There is increasing interest in this research area due to the growing use of accommodating IOLs. However, the use of diclofenac sodium intracamerally is off label, and any solution that we have to prepare by ourselves carries the risk of mistakes and consequent toxic anterior segment syndrome (TASS).