Nepafenac Group Research Articles

Post-Intravitreal injection pain reduction using topical NSAIDS: A comparative study.

To compare the efficacy of two different topical non-steroidal anti-inflammatory drugs (NSAIDs) drops with versus without conservatives after intravitreal injections (IVIs). Prospective, randomized, placebo-controlled, single-blinded comparative study. A total of 308 eyes of 252 patients receiving an IVI of anti-vascular endothelial growth factor (anti-VEGF) were randomly assigned to receive either a single drop of nepafenac 0.1%, preservative-free diclofenac 0.1%, or artificial tears (control group) immediately after IVI. Primary outcome measure was pain scores immediately, six hours and twenty-four hours post- injection. 166 patients received one topical drop of NSAIDS, of which 90 in the diclofenac group and 76 in the nepafenac group. Additional 86 patients were included in the control group. Mean reported pain score was significantly lower at six hours after IVI in the preservative-free diclofenac group (17.1 ± 23.0) than in the nepafenac group (26.2 ± 31.9) and the control group (27.5 ± 29.2) (p = 0.03). At twenty-four hours post-injection there was no statistically significant difference between the groups. Patients reported less pain compared to previous IVIs and none referred to urgent health care, but these findings were not statistically significant. The use of topical preservative-free NSAIDs may be superior to preservative- containing NSAIDs in pain relief after IVIs and may be considered as part of the treatment protocol of this population.

Topical 0.1% Nepafenac versus 0.09% Bromfenac Eye Drops for Inflammation after Laser Peripheral Iridotomy: A Randomized Controlled Trial

To assess the safety and efficacy of 0.1% nepafenac versus 0.09% bromfenac eye drops in controlling inflammation after neodymium yttrium-aluminum-garnet (YAG) laser peripheral iridotomy (LPI). Single-masked, single-center, randomized controlled trial. One hundred and sixty eyes of patients with primary angle-closure suspect (PACS) and primary angle closure (PAC) undergoing bilateral LPI. Patients were randomized in a 1:1 ratio to receive 0.1% nepafenac thrice daily or 0.09% bromfenac eye drops twice daily for 2 weeks after neodymium YAG LPI. Assessment was performed by masked investigators at 2 weeks after LPI. A Glaucoma Symptom Scale (GSS) questionnaire was administered both at baseline and 2 weeks after LPI. Subjective comfort scores to the study medications were assessed on the basis of a Likert scale at 2 weeks after LPI. In patients with bilateral PACS or PAC, the right eye was analyzed, and in asymmetrical disease (i.e., when one eye had PACS and the other eye had PAC), the eye with PAC was analyzed. The primary outcome (end point) was uncontrolled inflammation, defined as symptomatic inflammation within 1 week after LPI, the presence of anterior chamber cells at 2 weeks, or rebound inflammation after medication discontinuation. The secondary outcome was patient-reported comfort levels with study medications based on the GSS and Likert scale. At 2 weeks after LPI, 7 patients (6 with PACS and 1 with PAC) in the nepafenac group and 2 patients with PACS in the bromfenac group achieved the primary end point, without a difference between the medication groups (P= 0.09). Post-LPI burning, smarting, and stinging was more common in the bromfenac group (P= 0.01), which also had a higher comfort score on the Likert scale (P= 0.004). The need for repeat LPI was comparable (10.0% in the nepafenac group vs. 15.4% in the bromfenac group; P= 0.22). A multivariate analysis revealed that a greater number of laser shots was associated with the need for repeat LPI (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P= 0.04). Topical 0.09% bromfenac is noninferior to 0.1% nepafenac in controlling inflammation after LPI in eyes with PACS and PAC. Nepafenac may be associated with higher patient-reported comfort.

INHIBITION OF SURGICALLY INDUCED MIOSIS WITH NEPAFENAC

Objective: To assess the efficacy of prophylactic administration of 0.1% nepafenac in the maintenance of trans-operative mydriasis following cataract surgery.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Oct 2018 to Mar 2019.
 Methodology: A total of 70 patients undergoing cataract surgery phacoemulsification were randomly placed in either the control group or the nepafenac group. Nepafenac eye drops were administered as one drop 8 hourly, 3 days before surgery. Control group didn’t receive any medication preoperatively Mydriasis was measured trans-operatively before surgery, after aspiration of the cortex, and then at the end of surgery. Patients of both groups received tobradex 2 weeks post-surgery.
 Results: Post-surgery statistically significant (0.001) difference was observed in the mean pupil size between the nepafenac group (7.88 ± 0.49) and the control group (6.57 ± 0.92 mm).
 Conclusion: Use of nepafenac prophylactically was very effective in maintenance of trans-operative mydriasis in cataract surgery.

Comparison of topical and intracameral nonsteroidal anti-inflammatory drugs on pupillary size and postoperative inflammation in cataract surgery

Purpose The aim of this study was to compare the changes in pupillary size, postoperative inflammation, and macular thickness in patients who were subjected to phacoemulsification and received different topical and intracameral NSAIDs. Patients and methods This was a prospective randomized study that recruited 284 patients with visually significant cataract for whom uneventful phacoemulsification with intraocular lens implantation was performed. Candidates were randomly assigned to receive preoperative topical nepafenac, topical ketorolac, intraoperative intracameral ketorolac, or no NSAIDs. Results Topical nepafenac, topical ketorolac, and intracameral ketorolac had significantly maintained less intraoperative pupil size fluctuation than the placebo group (P=0.033, 0.001, and 0.048, respectively). In addition, topical nepafenac-treated, topical ketorolac-treated, and intracameral ketorolac-treated groups had less postoperative anterior chamber cells than the placebo group at 1 day (P=0.019, 0.421, and 0.515, respectively) and at 1 week, postoperatively (P=0.037, 0.089, and 0.298, respectively). However, at 1 month postoperatively, all study groups had similar minimal anterior chamber reaction with an insignificant difference (P=0.237, 0.379, and 0.342, respectively). Retinal thickness increased in all study groups 1 month after cataract surgery. However, topical and intracameral ketorolac groups had significantly less central macular thickness change as compared with the placebo (P=0.009 and 0.004, respectively). Conclusion The use of topical or intracameral NSAIDs yielded less intraoperative fluctuation in pupil size and lower postoperative inflammation than the placebo group. The topical nepafenac group had less postoperative inflammation, whereas the ketorolac-treated patients had the least changes in retinal thickness.

Comparison of the Analgesic Effect of Nepafenac 0.1%, Ketorolac 0.5%, and Diclofenac 0.1% Ophthalmic Solution during Intravitreal Injection

Background: Pain during intravitreal injection (IVT) is inevitable and might reduce the patient’s compliance. Topical anesthetic eye drop usually is administered to reduce pain during IVT. However, severe ocular pain has been reported in some patients. The most effective anesthesia for IVT is still controversy. Objective: To evaluate the analgesic effect of three topical non-steroidal anti-inflammatory drugs (NSAIDs) eye drop, nepafenac 0.1%, ketorolac 0.5%, and diclofenac 0.1%, during IVT. Materials and Methods: The present study was a prospective randomized, double-blinded, placebo-controlled study. Patients undergoing intravitreal bevacizumab injections were randomly divided into four groups. Group 1, group 2, group 3, and group 4 received topical nepafenac 0.1%, topical ketorolac 0.5%, diclofenac 0.1%, and artificial tear (placebo), respectively. One hour after receiving the eye drops, all patients underwent IVT with topical anesthetic eye drop. Pain assessment was performed immediately after IVT using the Thai version of Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ consists of the main component of the SF-MPQ, the visual analogue scale (VAS), and the present pain intensity (PPI). Results: Eighty patients voluntarily enrolled in the present study. Median of VAS scores were 1.5 (0.8 to 4.6), 2.3 (1.5 to 4.6), 1.5 (1 to 3.2), and 2.4 (1.4 to 3.6) in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.159). Median of the main component of the SF-MPQ scores were 4 (1.25 to 5.75), 5 (2.25 to 11.5), 5 (1.25 to 9.5), and 5 (3 to 13), in nepafenac group, ketorolac group, diclofenac group and placebo group, respectively (p=0.409). Median of the PPI scores were 1 (1 to 1.75), 1 (1 to 2), 1 (1 to 1), and 1 (1 to 2), in nepafenac group, ketorolac group, diclofenac group, and placebo group, respectively (p=0.529). Conclusion: There were no significant differences in analgesic effect during IVT between topical NSAIDs, nepafenac 0.1%, ketorolac 0.5%, diclofenac 0.1%, and placebo. Keywords: Intravitreal injection; Analgesic effect; Topical NSAIDs eye drop; SF-MPQ

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

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

Comparison between 0.1% Nepafenac and 1% Prednisolone Eye Drop in Postoperative Management Following Micro-incisional Cataract Surgery.

PurposeTo compare the efficacy of 0.1% nepafenac and 1% prednisolone acetate eye drop in postoperative inflammation control in micro-incisional cataract surgery.MethodsWe conducted a prospective, randomized, comparative, single-blind study. All the patients underwent temporal 2.2-mm micro-incisional cataract surgery. They were randomized into two groups (group A and B). Group A received 0.1% nepafenac eye drops 4 times/day for 4 weeks and group B received 1% prednisolone acetate eye drops in tapering doses for 4 weeks after surgery. Both the groups received moxifloxacin 0.5% eye drops 4 times/day for 2 weeks. Patients were examined on 1st, 7th, and 30th postoperative days and parameters of postoperative inflammation were evaluated and noted at each visit.ResultsA total of 200 patients were enrolled in the study. However, five patients lost to follow up, group A had 97 and group B had 98 patients respectively. Results were statistically insignificant in terms of the difference in lid edema, conjunctival congestion, corneal edema, anterior chamber cells and flare between the two groups with p-values >0.05 for each parameter at each visit. However, the difference in mean central macular thickness between the groups was significant (205.713 ± 17.14 vs. 220.984 ± 32.83 in group A and B, respectively, p ≤ 0.001) at 1 month. Also, the mean pain score was significantly lower (p = 0.018) in the nepafenac group at day 7 of surgery.ConclusionsNepafenac is equally effective and non-inferior to prednisolone acetate in suppression and prevention of inflammation in postoperative period.

Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab.

To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.

Differences in pain and inflammation between Diclofenac 0.1% and Nepafenac 0.1% after cataract surgery

AIM: To compare pain level and inflammation between preoperative topical Diclofenac 0.1% and Nepafenac 0.1% in patients undergoing cataract surgery. METHODS: This research was designed as prospective randomized clinical trial and conducted in June to August 2017 at Dr. Yap Eye Hospital. There were 56 subjects underwent phacoemulsification operation (single operator) and diagnosed as senile cataract and no adverse events were found. Subjects were divided into 2 groups according to preoperative eye drop medication, namely Diclofenac group and Nepafenac group. Participants and phaco-surgeon were blind regarding to the treatment. Inflammation parameters (at 1, 7 and 14d follow up) such as pain, conjunctiva hyperemic, blepharospasm, flare and cell in anterior chamber level as the primary outcome, whereas density and morphology of corneal endothelial cells as the secondary outcome. RESULTS: There were no statistically difference in conjunctiva hyperemic and blepharospasm level between 2 groups at 1d (P=0.284, effect size=0.29, 95%CI=-0.09 to 0.31; P=0.254, effect size=0.31, 95%CI=-0.13 to 0.49, respectively) and 7d (P=1.000 and P=0.556, effect size=0.18, 95%CI=-0.08 to 0.16, respectively) postoperatively. The pain scores (during surgery, 1d and 14d postoperative) in Nepafenac group was statistically lower than Diclofenac group (P=0.006, effect size=0.77, 95%CI=0.24 to 1.34; P=0.045, effect size=0.39, 95%CI=-0.10 to 0.62; and P=0.014, effect size=0.69, 95%CI=-0.06 to 0.50, respectively). The degree of flare and cell in Nepafenac group was lower at the 1d after phacoemulsification (P=0.029, effect size=0.59, 95%CI=0.02 to 0.36). Reduction of corneal endothelial density between 2 groups was not statistically significant, however the reduction of hexagonal cell percentage at 7d after phacoemulsification was lower than Nepafenac group (P=0.042, effect size=-0.55, 95%CI=-2.33 to -0.03). CONCLUSION: The pain and flare-cell levels in Nepafenac group are lower when compared with Diclofenac group.

Role of Nepafenac 0.1% Ophthalmic Solution in Preventing Intraoperative Miosis during Phacoemulsification

Purpose: To compare 0.1% Nepafenac ophthalmic solution with placebo in terms of decreasing mean intraoperative miosis in patients undergoing cataract surgery.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of Ophthalmology, Holy-Family Hospital Rawalpindi from September 2017 to March 2018.&#x0D; Methods: A total of 150 eyes with senile cataract of patients between 40-80 years of age and of both genders, undergoing uneventful cataract surgery and fulfilling the inclusion criteria were included. Patients were divided into 2 equal groups. Group A received Nepafenac eye drops and group B received placebo drops (Preservative free artificial tears). The diameter of pupil as viewed through the operating microscope was measured with Castroviejo Caliper at following steps; immediately before the start of surgery (baseline), after complete nucleus removal and at the end of surgery.&#x0D; Results: Mean decrease in pupil size from the start of surgery to the end of phacoemulsification in Group A (nepafenac group) was 0.48 ± 0.26 mm while in Group B (placebo group) it was 1.40 ± 0.49 mm (P = 0.0001). Mean decrease in pupil size from start to end in Group A (Nepafenac group) was 0.75 ± 0.32 mm while in Group B (placebo group) was 2.02 ± 0.62 mm (P = 0.0001).&#x0D; Conclusion: Intraoperative miosis in terms of mean decrease in pupils size (both from start of surgery till phacoemulsification and also from start of surgery till end of surgery) was lower in 0.1% Nepafenac group as compared to placebo group.&#x0D; Key Words: Phacoemulsification, Miosis, Nepafenac.

How does nepafenac affect the choroidal thickness after uneventful cataract surgery?

To investigate the effects of topical nepafenac on choroidal thickness (CT) following uneventful phacoemulsification surgery (UPS) using enhanced depth imaging optical coherence tomography (EDI-OCT). This prospective study included 45 randomly selected eyes (23 eyes of 23 patients used nepafenac (nepafenac group) and 22 eyes of 22 control patients did not use nepafenac (nepafenac-free group)) undergoing small-incision UPS. All participants underwent full ophthalmologic examination. CT measurements were performed at subfoveal, 1.0 mm temporal, and 1.0 mm nasal using the EDI-OCT preoperatively, 1 day, 1 week, and 1 month postoperatively. The mean subfoveal, nasal, and temporal CT in the nepafenac-free group had changed from 268.95 ± 63.59 μm to 283.36 ± 65.63 μm, 237.22 ± 64.09 μm to 253.09 ± 67.27 μm, and 235.95 ± 75.22 μm to 259.09 ± 63.66 μm preoperatively to 1 month postoperatively, respectively (p < 0.001, p < 0.001, p < 0.001, respectively). The mean subfoveal, nasal, and temporal CT in the nepafenac group had changed from 259.65 ± 55.99 μm to 276.65 ± 59.21 μm, 236.34 ± 55.40 μm to 251.00 ± 62.39 μm, and 247.56 ± 50.88 μm to 261.13 ± 53.73 μm preoperatively to 1 month postoperatively, respectively (p < 0.001, p < 0.001, p < 0.001, respectively). The postoperative CT continued to increase significantly during the follow-up period in two groups. However, compared to the change from baseline to month 1, there was not a statistically significant difference between the groups at subfoveal, nasal, and temporal CT (p: 0.633, p: 0.865, and p: 0.328, respectively). UPS may cause a significant increase in CT. Although increasing in the CT was lower in the nepafenac group than the nepafenac-free group, there was not a statistically significant difference between the groups.

Safety and Efficacy of 0.1% Nepafenac versus 1% Prednisolone Acetate Eye Drops after Laser Peripheral Iridotomy: A Prospective, Randomized Trial

To compare 0.1% nepafenac, a topical nonsteroidal anti-inflammatory drop, with 1% prednisolone acetate in controlling inflammation after neodymium:yttrium-aluminum-garnet laser peripheral iridotomy (LPI) in primary angle-closure suspects (PACS). Randomized controlled trial. One hundred fifty-two PACS undergoing bilateral LPI. Patients were randomized to 0.1% nepafenac or 1% prednisolone acetate eye drops in both eyes. Medications were given 4 times daily for 7 days, then twice daily for additional 7 days. Investigators were masked to the type of medication. Right eyes in patients with bilateral PACS and the PACS eye in asymmetrical disease (primary angle closure in fellow eye) were analyzed. Noninferior control of inflammation, defined as absence of cell in the anterior chamber at 2 weeks and absence of rebound iritis with medication discontinuation, was the primary outcome, whereas difference in the rise in intraocular pressure (IOP) was a secondary outcome. Both groups were comparable in baseline characteristics, including IOP and total laser energy. Nepafenac was noninferior to prednisolone with regard to inflammation control, with 1 nepafenac-treated eye (1.3%) not meeting the primary end point because of 1+ anterior chamber cell at 2 weeks and 4 prednisolone-treated eyes (5.4%) failing to meet the primary end point because of rebound iritis (P < 0.001). A greater increase in IOP from baseline to 2 weeks was observed in the prednisolone group compared with the nepafenac group (+2.6 mmHg vs.+0.6 mmHg; P= 0.004), although at 4 weeks, IOP was not significantly different than baseline in either group (P > 0.05 for both). Two weeks after LPI, 3 nepafenac-treated eyes and 10 prednisolone-treated eyes demonstrated a 6- to 15-mmHg IOP elevation from baseline (P= 0.10), whereas 2 prednisolone-treated eyes and no nepafenac-treated eyes showed IOP elevation of more than 15 mmHg (P= 0.20). Four weeks after LPI, more prednisolone-treated eyes showed IOP elevation of 6 to 15 mmHg as compared with nepafenac-treated eyes (6 eyes vs. 1 eye; P= 0.04); no eyes showed IOP elevation of more than 15 mmHg. Nepafenac was noninferior to prednisolone in controlling inflammation after LPI in PACS.

The importance of preoperative topical non-steroidal antiinflammatory agents in cataract surgery- an open label prospective randomised comparative study

Introduction: Intraoperative miosis is a problem which can lead to various complications that may adversely affect the outcome of cataract surgery. Topical non-steroidal anti-inflammatory drugs (NSAIDs) have been found to be helpful in reducing the intraoperative miosis. We tried to compare the effectiveness of two such molecules bromfenac and nepafenac. Objective: To compare the effectiveness of topical bromfenac (0.09%) and nepafenac (0.1%) in maintaining mydriasis and controlling immediate post-operative inflammation in cataract surgery. Methods: This is a prospective, randomised, open-label, comparative study of patients with senile cataract posted for cataract extraction and intra-ocular lens (IOL) implantation. The patients were randomised into 3 groups: topical moxifloxacilin 0.5% alone (control group or group A), topical bromfenac 0.09% + moxifloxacilin 0.5% (group B) and topical nepafenac 0.1% + moxifloxacilin 0.5% (group C). The drops were started one day before surgery. Mean pupil diameter was measured before starting surgery and after implanting IOL. Slit lamp examination was done on first postoperative day to look for anterior chamber reaction. The values were compared among the 3 groups. Results: The total loss of mean pupillary diameter was significant (p &lt; 0.0001) in control group (25.87%) as compared to bromfenac (3.51%) and nepafenac (3.81%) group. Post-operative inflammation was significantly less (p &lt;0.0001) in bromfenac and nepafenac group as compared to that of control group. Loss of mydriasis and post-operative inflammation was similar in both bromfenac and nepafenac group. Conclusion: Both bromfenac and nepafenac given topically prior to cataract surgery are equally effective in maintaining mydriasis during surgery as well as in controlling immediate postoperative inflammation.

Bromfenac Ophthalmic Solution 0.07% Versus Nepafenac Ophthalmic Suspension 0.3% for Post-Cataract Surgery Inflammation: A Pilot Study of Identical Dosing Regimens with Pre-Surgical "Pulse" Dose.

IntroductionThis small pilot study is the first direct comparison of the currently marketed formulations of bromfenac (0.07% solution) and nepafenac (0.3% suspension) using identical dosing regimens and including an extra pre-surgical “pulse” dose in patients undergoing cataract surgery.MethodsAdults scheduled for unilateral phacoemulsification with intraocular lens implantation were randomly assigned to bromfenac 0.07% or nepafenac 0.3%, each given once-daily 1 day prior to surgery, on the day of surgery plus an extra dose 1 h before surgery, and for 14 days after surgery. Assessments included summed ocular inflammation score (SOIS), visual acuity (VA), and retinal thickness measured via optical coherence tomography.ResultsThe study population included 49 patients (bromfenac, n = 24; nepafenac, n = 25). The percentage of patients with a SOIS = 0 (no cells or flare) at post-surgical day 15 (primary efficacy endpoint) was statistically similar between the bromfenac (57.1%) and nepafenac (50.0%) treatment groups (intent-to-treat with last observation carried forward) (P = 0.6318). The proportions of patients with an SOIS of 0 at days 3 and 8 were significantly (P < 0.05) higher in the bromfenac group (23.8 and 52.4%, respectively) versus the nepafenac group (0.0 and 20.8%, respectively). Visual acuity was similar between groups at each study visit, as were mean retinal thickness and change from baseline in retinal thickness. Rescue medication (typically difluprednate) was given on or before day 15 to 13 patients in each treatment group (bromfenac, 54.2%; nepafenac, 52.0%). There were no adverse events considered to be related to either treatment.ConclusionsThe results of this small pilot study suggest that once-daily bromfenac 0.07% produces similar benefits with regard to postsurgical inflammation, VA, and retinal thickness as once-daily nepafenac 0.3%, and possibly has a faster onset of anti-inflammatory action, when compared using identical dosing regimens.FundingBausch & Lomb Incorporated.Trial RegistrationNCT03886779.

Pain Control after Intravitreal Injection Using Topical Nepafenac 0.3% or Pressure Patching: A Randomized, Placebo-Controlled Trial

Pain after an intravitreal injection (IVI) can last up to 7 days and negatively impacts the patient's experience, potentially reducing treatment compliance. We prospectively evaluated topical nepafenac 0.3% suspension and patching for the reduction of pain after IVI. Randomized controlled trial. Sixty patients receiving an IVI of bevacizumab, aflibercept, or triamcinolone acetonide in 1 eye. Participants were randomized equally to receive either a single drop of nepafenac 0.3%, a pressure patch for 2 hours, or a single drop of preservative-free artificial tears (control group). A single-blinded placebo-controlled design was used to mask the topical treatment used. Pain was assessed using the Numeric Pain Rating Scale that ranged from 0 to 10 (horizontal pain scale). Because pain scores were not normally distributed, statistical analysis was performed using a nonparametric randomization-based analysis of covariance. Pain scores. Fifty-six and 53 patients of the 60 patients enrolled completed the 6- and 24-hour follow-ups, respectively. Numeric Pain Rating Scale scores at 6 and 24 hours after IVI were lower in the nepafenac group (0.8±0.3 and 0.1±0.1, respectively; n= 18) and the patching group (1.3±0.4 and 0.4±0.2, respectively; n= 19) compared with the control group (2.5±0.6 and 0.9±0.4, respectively; n= 19). After controlling for age, gender, number of prior injections, and physician administering the injection, patients in the nepafenac group reported significantly lower pain scores than those in the control group at 6 hours (1.3±0.6 less; P= 0.047) and 24 hours (0.7±0.3 less; P= 0.047). Although the patching group reported lower pain scores than the control group, this was not statistically significant (6 hours, P= 0.24; 24 hours, P= 0.29). Nepafenac 0.3% was effective as a single drop in reducing pain at 6 and 24 hours after IVI compared with placebo. Limited patching was associated with lower pain scores than placebo, but the difference was not statistically significant. Additional studies are needed to determine the most effective method to maximize the patient's experience after an IVI without sacrificing outcomes.

Comparison of Once-Daily Bromfenac 0.07% Versus Once-Daily Nepafenac 0.3% in Patients Undergoing Phacoemulsification.

AimRandomized pilot study comparing clinical outcomes with bromfenac ophthalmic solution 0.07% versus nepafenac 0.3% ophthalmic suspension administered as identical dosing regimens in patients undergoing uncomplicated phacoemulsification with intraocular lens implantation.MethodsForty-nine subjects were treated with bromfenac (n = 25) or nepafenac (n = 24) once daily starting 3 days before cataract surgery, continued on the day of surgery, and for 21 days following surgery, in addition to standard of care. Subjects were followed at 1 day and 7, 21, and 42 days postoperatively. Assessments included best-corrected visual acuity [Early Treatment Diabetic Retinopathy Study (ETDRS)], summed ocular inflammation score (SOIS; anterior chamber cells plus flare grading), macular volume and thickness (spectral domain optical coherence tomography), intraocular pressure, and adverse events.ResultsTreatment groups were similar at baseline. Outcomes for mean letters read (p = 0.20), mean change in macular volume (p = 0.98), and retinal thickness (p = 0.93) were not statistically different between the groups at day 42. Mean SOIS dropped markedly and similarly from post-surgical day 1 to day 7 in both treatment groups and was statistically equivalent to baseline in both groups by day 21. At day 42, 87% of subjects in the bromfenac group and 82% of subjects in the nepafenac group demonstrated stable or improved visual acuity. The proportions of eyes with mean retinal thickness of 10 µm or less at days 7, 21, and 42 were similar for the bromfenac (95.8%, 78.3%, 73.9%, respectively) and nepafenac (91.7%, 87.5%, 66.7%) groups (all p = NS, bromfenac vs. nepafenac).ConclusionBoth bromfenac 0.07% and nepafenac 0.3% produced positive and similar clinical outcomes with regard to ETDRS visual acuity post-cataract surgery when dosed using identical regimens. Increases in mean retinal thickness and mean macular volume were small and similar between treatments.Trial Registration numberNCT01847638.FundingBausch & Lomb Incorporated.

A comparative study between topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients attending a tertiary care center in West Bengal

Background: Ocular inflammation, which is common after cataract surgery, may cause patients to have postoperative pain and photophobia. Topical nonsteroidal anti-inflammatory drugs have been shown to be clinically effective in controlling inflammation after cataract surgery. Aim: The present study aims to compare topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients. Materials and Methods: A total of 212 patients were included in the study and randomly allocated in two equal groups to receive either nepafenac (0.1%) or ketorolac (0.5%). Patients underwent cataract extraction on the scheduled date by manual small incision cataract extraction. The drug application was started on the day of operation. For both the groups, the drug was applied thrice daily. The ocular parameters were observed and noted down according to group assigned successively on day 1, day 3, day 7, day 14, and day 28. Results: There was no significant difference between the two drugs as far as visual acuity, and intraocular pressure outcome was concerned. The effect of nepafenac (0.1%) on anterior chamber cells and flare was more than ketorolac (0.5%) during 1st week (up to day 7), but at the end of the observation period (28 days), the effect was similar with both drugs. In nepafenac (0.1%) group, higher percentage of patients was free from pain and ocular discomfort than that of ketorolac (0.5%) group throughout the observation period. Conclusion: Nepafenac (0.1%) was found superior than ketorolac (0.5%) in dealing with ocular discomfort and pain and with respect to early recovery from anterior chamber inflammation.

Tolerability and toxicity of topically applied nepafenac 0.3% compared with generic ketorolac 0.5%

To compare patient-reported tolerability, impact on quality of life, interference with activities of daily life, and ocular surface toxicity of branded nepafenac 0.3% and generic ketorolac 0.5% after cataract surgery. Harvard Eye Associates, Laguna Hills, California, and the Cincinnati Eye Institute, Ohio, USA. Prospective case series. One eye of each patient was randomized to receive ketorolac 0.5% or nepafenac 0.3% topical eyedrops for 3days preoperatively and 28days postoperatively. Additional medications were moxifloxacin 0.5% 4 times a day 3days preoperatively and 7days postoperatively and difluprednate 0.05% twice a day for 1weekpostoperatively. Primary endpoints were patient-reported tolerability of each drug, the related impact on quality of life, and activities of daily life. Secondary endpoints were differences in conjunctival hyperemia, anterior chamber inflammation, tear breakup time (TBUT), and corneal staining. Baseline characteristics were similar between the nepafenac group (n=91) and the ketorolac group (n=90). Burning and stinging lasted longer in the ketorolac group, whileblurry/hazy/foggy vision and a film or coating on the eye lasted longer in the nepafenac group (all P<.0001). All objective measures were statistically significant for ketorolac 0.5% versus nepafenac 0.3% as follows: corneal staining (64% versus 28%); Oxford grade 2 or greater staining (28% versus 4%); Schulze grade 30 or greater conjunctival erythema (65% versus 36%, respectively); abnormal TBUT greater than 10seconds (77% versus 51%) (all P<.0001). Branded nepafenac 0.3%-treated patients had significantly better objective and subjective outcomes after cataract surgery than generic ketorolac 0.5%-treated patients.

Comparative study of the efficacy and safety of bromfenac, nepafenac and diclofenac sodium for the prevention of cystoid macular edema after phacoemulsification.

To compare the efficacy, tolerability and safety of bromfenac 0.09%, nepafenac 0.1% or diclofenac 0.1% for the prophylaxis of the cystoid macular edema (CME) after phacoemulsification. Group sequential observational comparative study. After phacoemulsification, patients received two months for topical treatment of either diclofenac sodium, bromfenac or nepafenac. All patients received concomitant topical tobramycin 0.3% and topical prednisolone 1%. We measured CME using optical coherence tomography (OCT) central foveal thickness, macular thickness and total macular volume. We enrolled 243 patients from January to June 2015, and 35% received diclofenac, 32.9% bromfenac and 32.1% nepafenac. When we compared pre-operative to three weeks to two months, bromfenac was more effective in reducing foveal volume (21.3 and 35.4 mm3, respectively), compared with the diclofenac (1.3 and 11.5 mm3, respectively), and the nepafenac group, became more edematous 6.4 and 5.3, respectively. Totally 133 patients completed the post-surgical satisfaction questionnaire. Patients complained of eye stickiness in 13.8% whom we gave nepafenac, versus 10.3% whom we gave diclofenac sodium, and in 0 whom we gave bromfenac. Bromfenac is the best tolerated and is more effective than diclofenac and nepafenac in reducing CME after phacoemulsification.

Intraindividual comparison of nepafenac 0.3% for the prevention of macular edema after phacoemulsification

To compare the antiinflammatory efficacy of topical nepafenac 0.3% for prophylaxis of macular edema after cataract extraction. São Paulo University, São Paulo, Brazil. Prospective randomized clinical trial. Patients with bilateral cataract were included in this study. Each patient was assigned randomly to receive nepafenac 0.3% drops in 1 eye and a placebo in the fellow eye. The primary outcome measure was the change in the mean spectral-domain optical coherence tomography central subfield thickness 5weeks postoperatively. The secondary outcome measures were the total macular volume 1, 5, and 12weeks postoperatively; the percentage of patients in both groups who developed macular edema, and the corrected distance visual acuity within 5weeks and 12weeks after cataract surgery. The study comprised 224 eyes of 112 patients. For all retinal thickness measurements, a significant increase in both groups was detected starting from the first postoperative week until 12weeks. At 5weeks, there was a statistically significant difference in central subfield thickness and total macular volume between the nepafenac group and control group (P=.01 and P<.001, respectively). At the fifth postoperative week, no eye in the nepafenac group and 4 eyes (3.57%) in the control group had macula edema, highlighting a trend toward a greater incidence in the control group. The between-group differences in visual outcomes were not statistically significant. Used prophylactically after cataract surgery, nepafenac 0.3% was efficacious in reducing macular thickness compared with a placebo 5weeks postoperatively, without a difference in final visual acuity.