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Topical NSAID may decrease pain, inflammation after vitreoretinal surgery, but not macular edema
Retina. 2012;32(2):250-255.
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Topical nepafenac may safely reduce postoperative pain and inflammation following vitreoretinal surgery but may not be associated with reduction in macular edema or improvement in vision, a study found.
"Post-vitreoretinal surgery macular edema has a multifactorial etiology and the resultant retinal thickening is likely to be caused by interplay of factors both inherent to the surgery and the disease process. ... This is illustrated in our study by the fact that patients operated for dropped crystalline lens fragments and epiretinal membranes had a significantly worse macular edema that persisted for a longer duration with or without the addition of topical nepafenac," the authors wrote.
The investigator-masked, randomized, single-center, comparative case series included 60 patients who received Nevanac (nepafenac ophthalmic suspension 0.1%, Alcon) and 60 patients who received placebo after 20-gauge or 23-gauge pars plana vitrectomy.
Mean postoperative inflammation grades on day 1 were 0.95 ± 0.6 for the treatment group and 1.78 ± 0.7 for the placebo group (P = .002). At 4 weeks, mean central macular subfield thicknesses were 228.44 ± 29.27 µm and 236.21 ± 29.44 µm, respectively; at
8 weeks, thicknesses were 205.35 ± 25.25 µm and 205.37 ± 24.90 µm, respectively. No statistically significant difference in visual acuity was shown at 1 month.
Three patients who received nepafenac plus topical steroids and two who received steroids alone developed persistent epithelial defect; the authors noted that use of topical nepafenac in combination with corticosteroids could slow or delay healing, potentially resulting in epithelial breakdown and corneal melting.