Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac

Abstract

Objective:To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery.Methods:This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery.Results:The difference in mean pupil size, at the end of surgery, between the control group (6.84 ± 0.93 mm) and the nepafenac group (7.91 ± 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group.Conclusion:Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis.

A study on effect of pre-operative topical prednisolone acetate, nepafenac and placebo, on intraoperative mydriasis and its sustenance during cataract surgery: a randomized trial

“…These results were similar to those of Cervantes-Coste et al, who also found that the prophylactic use of nepafenac 0.1% was safe and effective in maintaining mydriasis during cataract surgery. 16 The use of topical prednisolone 1% to maintain the intraoperative mydriasis was superior to placebo. Shaikh et al, analyzed the antimiotic effect of topical prednisolone and flurbiprofen.…”

Ophthalmic nepafenac use in the Netherlands and Denmark

“…2015): maintenance of mydriasis during ophthalmic surgery (Cervantes‐Coste et al. 2009; Zanetti et al. 2012; Sarkar et al.…”

A Prospective, Randomized Controlled Study to Evaluate the Efficacy of Topical Flurbiprofen in Maintaining Intraoperative Mydriasis during Small Incision Cataract Surgery

“…5 In the present study, Flurbiprofen was administered 1 day preoperatively; however, whether administration 3 days prior to surgery would make any difference in the outcome is something that should be evaluated in the future. Due to the advances in surgical techniques there may be less tissue trauma and this may be the reason for preoperative use of Flurbiprofen being not statistically significant in decreasing intraoperative miosis.…”

“…3,4 In addition, non-steroidal anti-inflammatory drugs (NSAIDs), which directly inhibit the COX enzymes with the resultant inhibition of PG release are used to prevent surgically induced miosis. 5 The intraoperative…”