Comparison Between Topical Nepafenac and Flurbiprofen in Maintaining Intraoperative Mydriasis and Controlling Postoperative Inflammation in Cataract Surgery

Abstract

Background: Preoperative dilation of pupil is one of the prerequisistes to perform an uncomplicated cataract surgery. Intraoperative miosis is one of the many challenges which a surgeon can encounter during cataract surgery. Preoperative use of NSAIDS like nepefenac, flurbiprofen, ketorolac have been used for maintaining intra operative mydriasis and controlling postoperative inflammation by blocking prostaglandin synthesis. Aims: To compare the efficacy of nepafenac and flurbiprofen in maintaining intraoperative mydriasis and controlling postoperative inflammation Settings and Design: This was an institutional prospective comparative study done in rural Karnataka. Methods and Material: This study was performed on 110 patients, 55 were allocated in each group and were given either of the topical NSAID’s Nepafenac or Flurbiprofen prior to cataract surgery. Pupillary diameter was measured at the beginning and at the end of the surgery and the values were compared between the groups. Postoperative inflammation was also compared between both the groups. Statistical analysis used: The difference in flare and cells grading across groups were tested using Chi-Square test. p value of < 0.05 was considered statistically significant Results: The mean pupillary diameter of the two groups were comparable at the beginning of surgery The mean change in the pupillary diameter was more in flurbiprofen group when compared to nepafenac group. There was statistically significant difference among both the groups in maintenance of intraoperative mydriasis .The comparison of postoperative inflammation was also statistically different between both the groups. Conclusions: Pre-operative Nepafenac was found to be better than flurbiprofen in maintaining intraoperative mydriasis and controlling postoperative inflammation. Keywords: Cataract surgery, Surgical miosis, NSAIDs, Nepafenac, Flurbiprofen