Efficacy of Pre- and Postoperative Nepafenac 0.1% versus 0.3% in the Prevention of Cystoid Macular Edema after Phacoemulsification: A Randomized Controlled Trial
DOI:
https://doi.org/10.71000/g8grqx66Keywords:
cystoid macular edema; nepafenac; phacoemulsification; cataract surgery; optical coherence tomography; central macular thicknessAbstract
Background: Pseudophakic cystoid macular edema (PCME) is an inflammatory complication of cataract surgery that may present clinically or as postoperative macular thickening on optical coherence tomography (OCT). Topical nonsteroidal anti-inflammatory drugs (NSAIDs), including nepafenac, are widely used to suppress prostaglandin-mediated inflammation. Nepafenac 0.3% permits once-daily dosing, whereas the 0.1% formulation is administered three times daily.
Objective: To compare mean central macular thickness (CMT) four weeks after phacoemulsification in patients receiving nepafenac 0.1% three times daily versus nepafenac 0.3% once daily, with treatment initiated one day before surgery.
Methods: This randomized controlled trial was conducted at the Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, from 1 February to 31 July 2023. A total of 140 patients aged 35–65 years undergoing uneventful phacoemulsification were randomized in a 1:1 ratio to nepafenac 0.1% three times daily (Group A, n=70) or nepafenac 0.3% once daily (Group B, n=70). CMT was measured by spectral-domain OCT at baseline and four weeks postoperatively. Between-group comparisons were performed using independent-samples t tests, with mean differences and 95% confidence intervals reported.
Results: Baseline CMT was comparable between Group A and Group B (387.62±8.79 µm vs 389.33±10.31 µm; mean difference 1.71 µm, 95% CI −1.49 to 4.91; p=0.293). At four weeks, mean CMT was significantly lower in Group B than Group A (319.71±9.97 µm vs 342.60±5.95 µm), with a between-group difference of 22.89 µm (95% CI 20.14–25.64; p<0.001). The same direction of effect was observed across age and sex strata. Mean CMT decreased by 45.02 µm (11.6%) in Group A and 69.62 µm (17.9%) in Group B.
Conclusion: Once-daily nepafenac 0.3% produced a significantly lower four-week postoperative CMT than thrice-daily nepafenac 0.1% after uneventful phacoemulsification, supporting a stronger short-term effect on postoperative macular thickening together with a more convenient dosing schedule.
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