To compare Nepafenac effect on foveal thickness (FT), total macular volume (TMV), and BCVA after cataract surgery when added to the common regimen of topical steroids perioperatively.
Methods
PubMed, Scopus, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched systematically on April 28, 2022, for RCTs. Our primary outcome was the change in FT at final follow-up visits. We also considered FT at different follow-up durations, TMV, and visual outcome. We summarized our analyses by calculating the mean differences (MD) with associated 95% confidence intervals (CI) using restricted maximum likelihood in random effects models for continuous outcomes. The individual trials were evaluated for quality utilizing the Cochrane Collaboration's risk of bias assessment tool.
Results
Twenty-four RCTs totaling 4716 eyes were eligible. A significant difference was found between Nepafenac group and control group in the change in FT at final follow-up visit (MD, −11.622; 95% Cl [−17.475, −5.769]), at one week follow-up visit (MD, −6.409; 95% Cl [−13.148, 0.330]), at one month follow-up visit (MD, −9.090; 95% Cl [−13.260, −4.919]), at two months (MD, −5.769; 95% Cl (−22.477, −10.939]), and at three-month follow-up visit (MD, −12.913; 95% Cl [−22.254, −3.572]). However, there was no significant difference between the two groups regarding change in TMV at final follow-up visit. Nevertheless, a significant difference was found between the two groups regarding post-operative BCVA only at three-month follow-up visit.
Conclusion
Topical Nepafenac in addition to topical steroid is superior to the common regimen of topical steroid alone perioperatively in the prevention of macular swelling.
TranosPGWickremasingheSSStangosNT, et al.Macular edema. Surv Ophthalmol2004; 49: 470–490.
2.
GallemoreR. NSAIDs in treatment of retinal disorders. Rev Ophth2006; 13: 81–88.
3.
ZhangRDongLYangQ, et al.Prophylactic interventions for preventing macular edema after cataract surgery in patients with diabetes: A Bayesian network meta-analysis of randomized controlled trials. eClinicalMedicine2022; 49. doi:https://doi.org/10.1016/j.eclinm.2022.101463.
4.
PoweNRScheinODGieserSC, et al.Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular Lens implantation. Arch Ophthalmol1994; 112: 239–252.
5.
UrsellPGSpaltonDJWhitcupSM, et al.Cystoid macular edema after phacoemulsification: relationship to blood–aqueous barrier damage and visual acuity. J Cataract Refract Surg1999; 25: 1492–1497.
6.
KimSJEquiRBresslerNM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology2007; 114: 881–889.
7.
KleinBEKleinRMossSE. Incidence of cataract surgery in the Wisconsin epidemiologic study of diabetic retinopathy. Am J Ophthalmol1995; 119: 295–300.
8.
BosciaFGiancipoliED'Amico RicciG, et al.Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol2017; 28: 23–28.
9.
LiuY-CWilkinsMKimT, et al.Cataracts. Lancet2017; 390: 600–612.
10.
HollóGAungTCantorLB, et al.Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: mechanism, diagnosis, and management. Surv Ophthalmol2020; 65: 496–512.
11.
KesselLTendalBJørgensenKJ, et al.Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology2014; 121: 1915–1924.
12.
SinghRPLehmannRMartelJ, et al.Nepafenac 0.3% after cataract surgery in patients with diabetic retinopathy: results of 2 randomized phase 3 studies. Ophthalmology2017; 124: 776–785.
13.
PollackAStaurenghiGSagerD, et al.Prospective randomised clinical trial to evaluate the safety and efficacy of nepafenac 0.1% treatment for the prevention of macular oedema associated with cataract surgery in patients with diabetic retinopathy. Br J Ophthalmol2017; 101: 423–427.
14.
GamacheDAGraffGBradyMT, et al.Nepafenac, a unique nonsteroidal prodrug with potential utility in the treatment of trauma-induced ocular inflammation: i. Assessment of anti-inflammatory efficacy. Inflammation2000; 24: 357–370.
15.
SinghRAlpernLJaffeGJ, et al.Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol2012; 6: 1259–1269.
16.
ZaczekAArtzenDLaurellCG, et al.Nepafenac 0.1% plus dexamethasone 0.1% versus dexamethasone alone: effect on macular swelling after cataract surgery. J Cataract Refract Surg2014; 40: 1498–1505.
17.
Cervantes-CosteGSánchez-CastroYGOrozco-CarrollM, et al.Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac. Clin Ophthalmol2009; 3: 219–226.
18.
TzelikisPFMoratoCSNevesNT, et al.Intraindividual comparison of nepafenac 0.3% for the prevention of macular edema after phacoemulsification. J Cataract Refract Surg2018; 44: 440–446.
19.
MiyakeKOtaIMiyakeG, et al.Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery. J Cataract Refract Surg2011; 37: 1581–1588.
20.
WieldersLHPLambermontVASchoutenJSAG, et al.Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis. Am J Ophthalmol2015; 160: 968–981. e33.
21.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: n71.
22.
BeckRWMokePSTurpinAH, et al.A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol2003; 135: 194–205.
23.
CumpstonMLiTPageMJ, et al.Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev2019; 10: Ed000142.
24.
ViechtbauerW. Conducting meta-analyses in R with the metafor package. J Stat Softw2010; 36: 1–48.
25.
WallaceBCDahabrehIJTrikalinosTA, et al.Closing the gap between methodologists and End-users: r as a computational back-End. J Stat Softw2012; 49: 1–15.
26.
HigginsJPThomasJChandlerJ, et al.Cochrane handbook for systematic reviews of interventions. Hoboken, NJ: John Wiley & Sons, 2019.
27.
WanXWangWLiuJ, et al.Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol2014; 14: 135.
28.
SarfrazMHHaqRIMehboobMA. Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy. Pak J Med Sci2017; 33: 210–214.
29.
AlnagdyAAAbouelkheirHYEl-KhoulySE, et al.Impact of topical nonsteroidal anti-inflammatory drugs in prevention of macular edema following cataract surgery in diabetic patients. Int J Ophthalmol2018; 11: 616–622.
30.
CaginiCCerquagliaAPellegrinoA, et al.Effect of preoperative topical nepafenac 0.1% on inflammatory response after uncomplicated cataract surgery in healthy subjects. Acta Ophthalmol2021; 99: e70–e73.
31.
CampaCSalsiniGPerriP. Comparison of the efficacy of dexamethasone, nepafenac, and bromfenac for preventing pseudophakic cystoid macular edema: an open-label, prospective, randomized controlled trial. Curr Eye Res2018; 43: 362–367.
32.
ŞahinAKKüknerAUlaşF, et al.Effect of nepafenac 0.1% on retinal thickness after cataract surgery in patients without risk factors for cystoid macular edema. Int J Ophthalmol2020; 13: 1901–1907.
33.
AlmeidaDRKhanZXingL, et al.Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoemulsification. J Cataract Refract Surg2012; 38: 1537–1543.
34.
El GharbawySADarwishEAAbu EleinenKG, et al.Efficacy of addition of nepafenac 0.1% to steroid eye drops in prevention of post-phaco macular edema in high-risk eyes. Eur J Ophthalmol2019; 29: 453–457.
35.
HowaidyAEldalyZHAnisM, et al.Prophylaxis of macular edema after cataract surgery in diabetic patients, topical nepafenac versus intravitreal ranibizumab. Eur J Ophthalmol2022; 32: 205–212.
36.
IlveskoskiLTaipaleCTuuminenR. Anti-inflammatory medication of cataract surgery in pseudoexfoliation syndrome – NSAID is needed. Curr Eye Res2020; 45: 814–819.
37.
MathysKCCohenKL. Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema. Eye (Lond)2010; 24: 90–96.
38.
MokbelTSalehSAbdelkaderM, et al.Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients. Int J Ophthalmol2019; 12: 387–392.
39.
McCaffertySHarrisAKewC. Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo. BMC Ophthalmol2017; 17: 16.
40.
TzelikisPFVieiraMHidaWT, et al.Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study. Br J Ophthalmol2015; 99: 654–658.
41.
ElSobkyHAhmed MadiHAzizM. Nepafenac and bromfenac versus a placebo in minimizing the incidence of pseudophakic cystoid macular edema after phacoemulsification. Original article. Menoufia Medical Journal2020; 33: 1131–1138.
42.
SinghalDNandaAKanungoS, et al.A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification. Indian J Ophthalmol2022; 70: 425–433.
43.
SahuSRamJBansalR, et al.Effect of topical ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09% on postoperative inflammation using laser flare photometry in patients having phacoemulsification. J Cataract Refract Surg2015; 41: 2043–2048.
44.
StockRAGalvanDKGodoyR, et al.Comparison of macular thickness by optical coherence tomography measurements after uneventful phacoemulsification using ketorolac tromethamine, nepafenac, vs a control group, preoperatively and postoperatively. Clin Ophthalmol2018; 12: 607–611.
45.
HariprasadSMAkdumanLCleverJA, et al.Treatment of cystoid macular edema with the new-generation NSAID nepafenac 0.1%. Clin Ophthalmol2009; 3: 147–154.
46.
KapinMAYanniJMBradyMT, et al.Inflammation-mediated retinal edema in the rabbit is inhibited by topical nepafenac. Inflammation2003; 27: 281–291.
47.
LindstromRKimT. Ocular permeation and inhibition of retinal inflammation: an examination of data and expert opinion on the clinical utility of nepafenac. Curr Med Res Opin2006; 22: 397–404.
48.
ChastainJESandersMECurtisMA, et al.Distribution of topical ocular nepafenac and its active metabolite amfenac to the posterior segment of the eye. Exp Eye Res2016; 145: 58–67.
49.
PleyerUUrsellPGRamaP. Intraocular pressure effects of common topical steroids for post-cataract inflammation: are they all the same?Ophthalmol Ther2013; 2: 55–72.
50.
JiangJShihanMHWangY, et al.Lens epithelial cells initiate an inflammatory response following cataract surgery. Invest Ophthalmol Visual Sci2018; 59: 4986–4997.
51.
VinoresSASenHCampochiaroPA. An adenosine agonist and prostaglandin E1 cause breakdown of the blood-retinal barrier by opening tight junctions between vascular endothelial cells. Invest Ophthalmol Visual Sci1992; 33: 1870–1878.
52.
WieldersLHLambermontVASchoutenJS, et al.Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis. Am J Ophthalmol2015; 160: 968–981. e33.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
