Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with nonproliferative diabetic retinopathy

Abstract

Objective:To determine the efficacy of topical Nepafenac (0.1%), administered post-operatively in prevention of Macular Edema (ME), after cataract surgery in patients with Non-Proliferative Diabetic Retinopathy (NPDR).Methods:This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from Sep 2015 to Sep 2016. Sixty eyes of 60 patients with NPDR underwent phacoemulsification with intraocular lens implantation. Group 1 received 0.1% Nepafenac, 8-hourly, in operated eye after cataract surgery for three months, along with routine post-operative medications. Group-2 received only routine post-operative medications. ME was defined as increase in Central Macular Thickness (CMT) of >10% from pre-operative baseline, measured using spectral domain optical coherence tomography.Results:Mean age of study population was 60.97±4.91 years. Out of 60 patients, 34 (56.7%) were males and 24 (43.3%) were females. Mean pre-operative CMT, 3 months post-operative CMT, mean change in CMT and mean frequency change in CMT of Group-1 was 226.5±10.86µm, 228.83±14.56 µm, 2.33±10.45 µm and 1.05% respectively. Mean pre-operative CMT, three months post-operative CMT, mean change in CMT and mean frequency change in CMT in Group-2 was 223.93±11.69µm, 236.17±16.16 µm, 12.23±12.40µm and 5.51% respectively. ME was observed in one patient (3.3%) in Group-1, and seven patients (23.3%) in Group 2. The difference of mean change in CMT and frequency change in CMT between groups was statistically significant (p<0.05).Conclusion:0.1% topical Nepafenac is effective in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR).

Prevention and treatment of cystoid macular edema after cataract surgery

“…42,45 Topical bromfenac, nepafenac and ketorolac all diffuse into the vitreous humor to a measurable degree. 46 The availability in ocular tissues is reported to be highest after topical administration of bromfenac. 47 Bromfenac and amfenac are the most potent inhibitors of COX-2, which is considered the most important isoform of COX involved in inflammatory responses.…”

“…Only one patient (3.7%) in the ranibizumab group developed clinically significant CME at three months postoperatively, as compared to six patients (22.2%) in the control group. 46 …”

“…Six trials stated that the treatment allocation was concealed from the investigators. 18,19,29,32,45,46 Six trials were open-label studies. 22,23,31,43,44,46 …”

“…This study showed no statistically significant difference in the odds of developing CME between both treatment groups (OR 1.18; 95% CI 0.53-2.62). 46 None of the studies investigated the change in FT or MV after cataract surgery. Eight trials reported the change in CDVA within 3 months postoperatively or both the preoperative and postoperative CDVA.…”

“…37,40,[43][44][45][46][47] Additional perioperative interventions may be needed to adequately reduce the odds of developing CME in these high-risk cases. ESCRS PREMED study report 2 has shown that a subconjunctival injection with 40 mg triamcinolone acetonide (TA) can effectively prevent the occurrence of CME in patients with DM.…”