Title : Diclofenac versus Corticosteroids following strabismus surgery: Systematic review and meta-analysis
Abstract:
The current study aims to compare outcomes of diclofenac versus corticosteroids following strabismus surgery. A systematic review and meta-analysis were performed in line with the PRISMA guidelines. An electronic search was performed to include comparative studies of diclofenac versus corticosteroids following strabismus surgery. The analysis was based on fixed and random effect models. Primary outcomes included discomfort, chemosis, inflammation, conjunctival gap, intraocular pressure (IOP) and conjunctival injection. Secondary outcomes were conjunctival congestion, discharge and drop intolerance. Eight studies with a sample of 469 eyes were included. At weeks 1 and 4 post-operatively, there were no statistically significant differences between diclofenac and corticosteroid groups, except for conjunctival injection at week 1 (Mean Difference [MD]=-0.21, P=0.04) favoring diclofenac. Interestingly, all primary outcomes significantly favored diclofenac at week 2, namely discomfort (MD=-0.34, P=0.03), conjunctival chemosis (MD=-0.16, P=0.04), conjunctival inflammation (MD=-0.16, P=0.02), conjunctival gap (MD=-0.17, P=0.002), IOP (MD=-2.53, P<0.00001) and conjunctival injection (MD=-0.30, P=0.03). Moreover, conjunctival congestion was significantly improved for dexamethasone whilst discharge and drop intolerance was not statistically different. In conclusion, diclofenac is comparable to various corticosteroids when used following strabismus surgery. However, it is important to note that diclofenac yielded significant improvements in discomfort, conjunctival chemosis, inflammation, conjunctival gap, IOP and conjunctival injection mainly at two weeks post-operatively.
