Role of prophylactic topical nepafenac in prevention of post pars‐plana vitrectomy macular edema

Abstract

Abstract Purpose To evaluate the effects of topical nepafenac in patients undergoing pars plana vitrectomy (PPV) with special emphasis on its role in post PPV macular edema. Methods 108 patients undergoing PPV were randomized to receive either topical nepafenac 0.3% (53 eyes) or placebo (55 eyes) from 3 days preoperatively till 4 weeks postoperative in addition to topical steroids and antibiotics in this single center investigator masked study. Optical coherence tomography (OCT) was done at week 2,4,6 and 8 post operatively. Results Patients taking nepafenac and those taking placebo had mean postoperative day 1 pain scores of 0.25 and 1.08 (P=0.03) and mean inflammation grades of 0.49 and 1.34 (P=0.002) respectively. Although centre subfield macular thickness (CSMT) was lesser in nepafenac group as compared to placebo group (260.56 µm Vs 270.70 µm at week 2, 228.44 µm Vs 236.21 µm at week 4, 215.02 µm Vs 218.74 µm at week 6 and 205.35 µm Vs 205.17 µm at week 8 respectively), the difference did not reach statistically significant levels (P>0.05) at any visit. There was also, no statistically significant improvement in best corrected visual acuity between the nepafenac group and the placebo group at any postoperative visit. Conclusion Although addition of 0.3% nepafenac decreased postoperative pain and inflammation, it did not reduce incidence of macular edema in patients undergoing PPV. Topical nepafenac was well tolerated and safe but did not improve visual recovery in this set of patients.