XXXI Congress of the European Society of Cataract and Refractive Surgeons: Nepafenac: First choice treatment

November 1, 2013

Nepafenac can be used to prevent the onset of cystoid macular oedema and as an alternative to cortisone to control the inflammatory effects of cataract surgery; this drug can be used to similar effect regardless of the experience of the surgeon, according to Dr Elisa Tosco.

Nepafenac can be used to prevent the onset of cystoid macular oedema (CME) and as an alternative to cortisone to control the inflammatory effects of cataract surgery; this drug is considered excellent with good reason, and can be used to similar effect regardless of the experience of the surgeon, according to Dr Elisa Tosco (Presidio Ospedaliero di Chiari; Chiari Brescia, Italy) in the 'Cystoid Macular Oedema and Infection' session that took place on Sunday afternoon during this year's ESCRS.

Dr Tosco and colleagues examined 100 patients with cataracts of varying degrees of opacification, who underwent phacoemulsification performed by four different surgeons of varying levels of experience, to determine how best to limit and control the inflammatory effects of the phacoemulsification procedure.

"The only criterion for exclusion from the study was treatment with non-steroidal anti-inflammatory drugs (NSAIDs), in case of posterior capsule rupture," said Dr Tosco.

Both groups had received prophylactic treatment with antibiotic and NSAID 3 days before the phacoemulsification procedure was performed. After phacoemulsification, each patient was evaluated at 1, 7 and 30 days postoperatively for signs of anterior segment inflammation (according to a subjective scale of 0–4 judged by a single surgeon), Descemet's folds, Tyndall effect in the anterior chamber and fibrosis of the capsular bag, with volume measured by OCT.

Treatment outcomes

In the first group of 57 patients, the average OCT measurement was 243.71 μm preoperatively, 248.52 μm at day 1, 251.62 μm at day 7 and 260.27 μm at day 30; the average OCT measurement values in the second group of patients (those treated with dexamethasone) were 235.61 μm preoperatively, 238.82 μm at day 1, 240.06 μm at day 7 and 245.97 μm at day 30.

"Descemet's folds, which had mainly been in evidence in patients treated by less-experienced surgeons with a higher percentage of ultrasound use, were absent at days 7 and 30," said Dr Tosco. "There were no differences between the two categories in terms of Tyndall effect and early fibrosis of the capsular bag, and no patients treated with NSAIDs suffered corneal damage related to long-term use or required therapy modification."

The team therefore concluded that, because no physiological signs were recorded, nepafenac is effective in preventing the onset of CME and in controlling the other inflammatory outcomes of phacoemulsification.

"We can conclude that Nepafenac can be considered an excellent alternative to cortisone in cataract surgery, controlling the inflammatory reaction without the usual cortisone side effects. For this reason Nepafenac by itself is a good solution not only for CME prevention but also for anti-inflammatory control after cataract surgery." Dr Tosco concluded.

Dr Tosco has indicated no financial disclosures relating to the content of this piece.