[Monotherapy vs combination therapy with topical prednisolone and indomethacin]

The anti-inflammatory effects of topical steroids and nonsteroidal anti-inflammatory drugs (NSAID) are claimed to be additive, according to fluorophotometric measurements. This finding was reevaluated using laser flare-cell photometry.

Thirty patients (61-79 years of age) without pre-existing deficiencies of the blood-aqueous barrier were investigated preoperatively as well as on day 1 and 3 after ECCE with IOL implantation. The laser flare-cell photometer (model FC-1000; Kowa Company) which was used for examination enables sensitive and exact in vivo determination of aqueous flare. The patients were randomly assigned to one of the following three treatment groups: group A, monotherapy with prednisolone 1% eyedrops (Inflanefran forte); group B, monotherapy with indomethacin 1% eyedrops (Chibro Amuno); group C, combination therapy with prednisolone 1% + indomethacin 1% eyedrops. One drop of either drug was administered five times per day to each patient, beginning immediately after completion of surgery. In addition, all patients received antibiotic therapy with gentamicin. Parabulbar or oral steroids were not administered.

Under monotherapy with prednisolone, the flare (photon counts/ms) on days 1 and 3 postoperatively averaged 30.9 and 27.8, respectively. Under indomethacin monotherapy, the flare values were similar (no significant differences). Under combination therapy with prednisolone+indomethacin, however, the flare values were significantly lower both on day 1 (24.2) and on day 3 (20.6).

Combination therapy with topical prednisolone+indomethacin thus seems superior to monotherapy with either of these agents. This confirms the previous fluorophotometric finding that the anti-inflammatory effects of topical steroids and NSAID are additive, a phenomenon attributable to different pharmacological sites of action.