Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema

Abstract

Purpose: To evaluate the use of topical nepafenac 0.1% after routine phacoemulsification in patients at low risk for cystoid macular oedema (CME) using optical coherence tomography (OCT) measurement of macular thickness.

Methods: Seventy-nine subjects with no risk factors for CME had uncomplicated bimanual micro-incision cataract surgery by an experienced surgeon. All subjects received preoperative nepafenac. Subjects were randomised to postoperative standard of care, consisting of a topical antibiotic for 10 days and topical corticosteroid for 1 month (control), or standard of care plus nepafenac for 1 month (treatment). OCT and ETDRS best-corrected visual acuity were measured preoperatively and 2 months postoperatively. Primary endpoints were comparison of changes in macular thickness between groups and the relationship of that change to postoperative vision.

Results: All subjects had excellent visual outcomes, with mean visual improvement of 15 letters. Cataract surgery was very efficient with a mean effective phaco time (EPT) of 4.99 and 6.90 s in the control and treatment groups, respectively. There were small increases in the central macular thickness in both the control (2.78 microm) and treatment (5.60 microm) groups. The change in macular thickness was statistically similar between groups and did not correlate with the final visual outcome.

Discussion: The small increase in macular thickness after routine cataract surgery is probably not clinically significant. In subjects undergoing routine cataract surgery, and at low risk for CME, the routine use of preoperative nepafenac may be all that is necessary to achieve excellent visual recovery.