Topical Diclofenac Sodium and Macular Microcirculation After Phacoemulsification: A Retrospective OCTA Analysis

Background To evaluate the effects of perioperative 0.1% topical diclofenac sodium ophthalmic solution on macular microcirculation in patients undergoing phacoemulsification, using optical coherence tomography angiography (OCTA). Methods This study analyzed 55 age-related cataract patients undergoing phacoemulsification. Participants were divided into control (n = 30) and experimental (n = 25) groups. The experimental group received prophylactic 0.1% diclofenac sodium (four times daily) starting 24h preoperatively and continuing for 1 month postoperatively, alongside standardized tobramycin-dexamethasone therapy. Optical coherence tomography angiography (OCTA) measurements of superficial vascular density (VD), perfusion density (PD), foveal avascular zone (FAZ) area, and central foveal thickness (CFT) were taken preoperatively and at 1-day, 1-week, and 1-month postoperative intervals. Results Both groups had significant temporal increases in VD and PD across regions (all P  < 0.01), with no significant differences between the two groups. However, controls showed greater VD and PD increases in central/paracentral/peripheral regions vs. experimental group at 1 month. CFT progression was slightly lower in experimental group (+ 3.91% vs + 5.68%) than control group. Conclusions Perioperative diclofenac sodium ophthalmic solution inhibited increase of macular microcirculatory parameters and postoperative CFT progression. While statistically insignificant, the use of nonsteroidal anti-inflammatory drugs remains recommended for cystoid macular edema prophylaxis in cataract surgery.