Nepafenac and bromfenac versus a placebo in minimizing the incidence of pseudophakic cystoid macular edema after phacoemulsification

Abstract

Objectives This study aims to evaluate the effect of two types of topical NSAIDs, nepafenac and bromfenac, in comparison with a placebo on macular edema after phacoemulsification. Background Cystoid macular edema (CME) is the commonest cause of visual decline after phacoemulsification. Design A prospective comparative randomized Open-label clinical trial was performed. Patients and methods A total of 75 patients with senile cataract were included in the present study. Of them, 19 patients were assigned to receive nepafenac 0.3% eye drops, 19 received bromfenac 0.09% eye drops, and 37 received a placebo. The primary outcome measure included the change in the mean spectral-domain optical coherence tomography central subfield thickness at 1 day, 1 week, 1, 2 and 3 months after surgery. The secondary outcome measures included the total macular volume at 1 day, 1 week, 1, 2, 3 months postoperatively; the percentage of eyes in each group that developed CME; and the corrected visual acuity on 6 and 12 weeks after surgery. Results For all retinal thickness measurements, a significant increase in all three groups had been detected, starting from the first week postoperatively. Compared with the control regimen, add-on bromfenac or nepafenac resulted in statistically significant minimization of the changes in the following parameters: change in the macular volume and the central subfield thickness. Conclusion Topical NSAIDs therapy 2 days before surgery has an additive effect in minimizing the risk of pseudophakic CME. Bromfenac has statistically surpassed nepafenac in minimizing the incidence of CME after uneventful phacoemulsification.