Comparison of once daily dose of 0.3% nepafenac alone and three times dose of 0.1% nepafenac alone in pain and inflammation control after phacoemulsification

Purpose: To compare the efficacy of a once?daily dose of 0.3% nepafenac and three times daily dose of 0.1% nepafenac in controlling pain and inflammation following phacoemulsification. Methods: In this prospective randomized control single?blind study. patients who underwent uneventful phacoemulsification were divided into two groups. Group A received 0.1% nepafenac eye drops three times/day for 4 weeks and group B received 0.3% nepafenac eye drops once daily for 4 weeks following phacoemulsification. All the patients received moxifloxacin 0.5% eye drops four times/day for 2 weeks. None of the patients in any group received any form of corticosteroids. Results: The mean age of the patients in group A was 63.55 ± 8.5 years, while in group B, it was 60.05 ± 7.76 years. There was no significant result in the preoperative baseline demographics and intraoperative parameters between both the groups. The results were statistically insignificant in terms of inflammatory markers between both groups on day 1. But, on day 7, group B showed better results in terms of lid edema, conjunctival congestion, and anterior chamber cells. The patients in group B also perceived significantly less pain on day 1 (P = 0.02) and day 7 (P < 0.001). The central macular thickness was also significantly lower in group B at day 30 (P < .001) and day 90 (P < .001), respectively. Conclusion: Once?daily dose of higher concentrated nepafenac (0.3%) is equally effective and shows better results than 0.1% nepafenac for pain and inflammation control.

Regression of macular edema with topical brinzolamide and nepafenac alone and identification of a novel gyrate atrophy mutation / Regressão de edema macular com o uso tópico de brinzolamida e nepafenac e identificação de uma nova mutação na atrofia girata

ABSTRACT Gyrate atrophy is a rare metabolic autosomal recessive disorder caused by ornithine aminotransferase enzyme deficiency that leads to characteristic progressive, degenerative chorioretinal findings. Patients complain mostly of low vision, night blindness, and peripheral vision loss. Posterior subcapsular cataract, myopia, choroid neovascularization, and intraretinal cysts may be accompanying factors related to vision loss. We encountered a patient with vision loss secondary to posterior subcapsular cataract and intraretinal cysts. After treatment with topical brinzolamide and nepafenac (and without any diet mo dification and/or supplementation), we observed 143- and 117-mm macular thickness resolutions with 2 and 1 Snellen lines of visual gain in his right and left eyes, respectively. Also, we detected a novel homozygous mutation in the ornithine aminotransferase gene: c.1253T>C (p.Leu418Pro). Carbonic anhydrase inhibitors and/or non-steroid anti-inflammatory drugs can control macular edema in patients with gyrate atrophy-associated intraretinal cysts. The genetic variants may also be a determinant in the responsiveness to the therapy type.

RESUMO A atrofia girata é um distúrbio autossômico recessivo metabólico raro causado pela deficiência da enzima ornitina ami notransferase, que leva a achados degenerativos coriorretinianos progressivos característicos. Os pacientes queixam-se principalmente de baixa visão, cegueira noturna e perda de vi são periférica. A catarata subcapsular posterior, a miopia, a neovascularização da coróide e os cistos intrarretinianos podem ser fatores associados à perda da visão. Encontramos um paciente com perda de visão secundária à catarata subcapsular posterior e cistos intrarretinianos. Após o tratamento com brinzolamida tópica e nepafenaco (e sem modificação e/ou suplementação da dieta), observamos resoluções de espessura macular de 143 e 117 mm e com 2 e 1 linhas de Snellen de ganho visual nos olhos direito e esquerdo, respectivamente. Além disso, detectamos uma nova mutação homozigótica no gene da ornitina aminotransfera se: c.1253T>C (p.Leu418Pro). Inibidores da anidrase carbônica e/ou drogas anti-inflamatórias não esteróides podem controlar o edema macular em pacientes com cistos intrarretinianos associados à atrofia girata. As variantes genéticas também podem ser determinantes na responsividade ao tipo de terapia.

A Prospective Interventional Study to Evaluate the Efficacy of Nepafenac 0.1% for Prevention of Macular Oedema Associated with Cataract Surgery in Patients with Diabetes

Pseudophakic cystoid macular oedema is a significant cause of suboptimal visual acuity post phacoemulsification.Diabetics are at greater risk of developing PCME following cataract surgery. Topical nepafenac ophthalmic suspension 0.1% is used to prevent inflammation postoperatively. We wanted to study the effect of Topical Nepafenac 0.1% eye suspension on macular thickness following phacoemulsification in patients of diabetes mellitus and correlate the final visual acuity and macular thickness.METHODSThis prospective interventional study was conducted between January 2018 and May 2019 in the Department of Ophthalmology, MMIMSR, Mullana, Ambala. 100 patients based on the inclusion and exclusion criteria were included in the study and phacoemulsification was done. They were divided in to two groups of 50 each. Group 1 received topical Nepafenac 0.1% ophthalmic suspension thrice daily along with the routine post-op medications whereas Group 2 received routine post-op medications. The groups were analysed preoperatively and at 2, 4, 6, 8 weeks postoperatively and their CMT was recorded using a SD-OCT. The change in BCVA was analysed with the help of ETDRS letter chart. The data was entered in Microsoft Excel and analysed using SPSS-PC-20 version. Quantitative data was expressed by mean and standard deviation while qualitative data was expressed as percentage. Difference between the proportions was tested with Chi Square Test or Fisher’s Exact test while difference between quantitative variable between the two groups was tested with students ’t’ test or Mann Whitney U test. For comparison of quantitative data between more than two groups, ANOVA or Kruskal Wallis ‘H’ test followed by post hoc test was used. A ‘p’ value of less than 0.05 was considered statistically significant.RESULTSA lower percentage of patients in Group 1 developed ME relative to Group 2 (2% vs. 8%; p-value= 0.36). The mean CMT was significantly lower in Group 1 at 2 (p-value<0.01), 4 (p-value<0.001), 6 (p-value<0.001) and 8 weeks (p-value<0.001). A greater percentage of patients in Group 1 (60%) experienced a gain of >15 letters as compared to the baseline (p-value<0.01)

Correlation of OPG and DEXA: A Case Control Study

Introduction: Osteoporosis is a common disorder affectingolder females. But it remains undetected in many cases. Theaim of the present study is to evaluate the correlation of lowerborder of mandible of OPG and bone mineral density changesas measured by dual energy x ray absorptiometry.Material and methods: 30 female patients were subjected toOPG and DEXA. The visual analysis of OPG was done andcompared with bone mineral density obtained by DEXA.Results: It was found that statistically no significant differencewas observed between OPG and DEXA technique.Conclusion: There is a significant correlation between lowerborder of mandible and bone mineral density. So visualestimation of panoramic radiograph can be used as a screeningtool for evaluation of osteoporosis.

Differences in pain and inflammation between Diclofenac 0.1% and Nepafenac 0.1% after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare pain level and inflammation between preoperative topical Diclofenac 0.1% and Nepafenac 0.1% in patients undergoing cataract surgery.<p>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.<p>RESULTS: There were no statistically difference in conjunctiva hyperemic and blepharospasm level between 2 groups at 1d(<i>P</i>=0.284, effect size=0.29, 95% <i>CI</i>=-0.09 to 0.31; <i>P</i>=0.254, effect size=0.31, 95% <i>CI</i>=-0.13 to 0.49, respectively)and 7d(<i>P</i>=1.000 and <i>P</i>=0.556, effect size=0.18, 95% <i>CI</i>=-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(<i>P</i>=0.006, effect size=0.77, 95% <i>CI</i>=0.24 to 1.34; <i>P</i>=0.045, effect size=0.39, 95% <i>CI</i>=-0.10 to 0.62; and <i>P</i>=0.014, effect size=0.69, 95%<i> CI</i>=-0.06 to 0.50, respectively). The degree of flare and cell in Nepafenac group was lower at the 1d after phacoemulsification(<i>P</i>=0.029, effect size=0.59, 95% <i>CI</i>=0.02 to 0.36). Reduction of corneal endothelial density between 2 groups were not statistically significant, however the reduction of hexagonal cell percentage at 7d after phacoemulsification was lower than Nepafenac group(<i>P</i>=0.042, effect size=-0.55, 95% <i>CI</i>=-2.33 to -0.03).<p>CONCLUSION: The pain and flare-cell levels in Nepafenac group was lower when compared with Diclofenac group.

A comparative study on efficacy of nepafenac and flurbiprofen in maintenance of intraoperative mydriasis during cataract surgery: an open label randomized controlled trial

Background: Surgery on the ocular tissue brings about activation of phospholipase A3 thereby releasing prostaglandins and leukotrienes. Prostaglandins bring about meiosis during surgery, changes in IOP, conjunctival hyperaemia. Newer topical NSAID抯 Nepafenac and Flurbiprofen are potent inhibitors of the cyclooxygenase enzyme thereby inhibiting the biosynthesis of prostaglandins. Objective of this study was to compare the efficacy of preoperative use of topical Nepafenac (0.1%) and Flurbiprofen (0.03%) in maintenance of intraoperative mydriasis during cataract surgery.Methods: A randomised, comparative study was performed on 104 patients, 52 were allocated in each group and were given either of the topical NSAID抯 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. Mean and standard deviation was calculated and between two groups comparison was done using students t-test.Results: The mean pupillary diameter of the two groups were comparable at the beginning of surgery (p=0.34). The mean change in the pupillary diameter was 1.86�71mm in the Nepafenac group and 1.77�72mm in the Flurbiprofen group. There was no statistically significant difference among both the groups in maintenance of intraoperative mydriasis (p=0.47).Conclusions: Pre-operative use of Nepafenac and Flurbiprofen were equally effective in preventing meiosis during cataract surgery.

Role of Topical Nepafenac and Topical Dexamethasone in Postoperative Inflammation after Cataract Surgery: A Comparative Study.

Background: To study the role of nonsteroidal anti-inflammatory Nepafenac 0.1% topically in comparison to topical steroid for controlling postoperative inflammation after cataract surgery. Methods: Prospective randomized controlled trials were given and double blind study was done. In both groups, similar baseline parameters were taken into consideration. Postoperative inflammation, intraocular pressure and visual acuity following routine small incision cataract surgery were assessed in both groups in first 21 days. Parameters were graded according to severity. Results: There was not much difference statistically in two groups in the treatment of any of the signs, including ciliary congestion, aqueous cells, flare, descemet’s folds, visual acuity and intraocular pressure (p 0.001) however, there was apparent improvement with corticosteroids when aqueous flare was considered but with Nepafenac there was no side effect and was well tolerated. Conclusion: Nepafenac is equally effective as topical steroid and can safely be used in routine postoperative inflammation after uncomplicated cataract surgery.

Effect of nepafenac 0.1% on macular thickness during immediate post operative period after phacoemulsification in patients with low risk for cystoid macular edema.

Introduction: To evaluate the effect of nepafenac 0.1% after routine phacoemulsification in patient at low risk for cystoids macular edema. Material and methods: This prospective hospital based study consists of 70 eyes of 70 subject with no risk factor for cystoid macular edema who underwent phacoemulsification by an experienced surgeon. All 70 subjects received preoperative nepafenac. 35 subjects received nepafenac post operatively (treatment). SD OCT (Spectral domain optical coherence tomography) and visual acuity measurement were taken pre op and post op (1 week, 1month). Final end point where comparison of macular thickness and visual acuity between two group. Result: All subjects in this study had excellent visual outcome post cataract extraction. There was small increase in macular thickness in both treatment and control group with no difference in visual acuity between first and second post op visits. Conclusion: There is an increase in macular thickness measured by OCT in low risk patients after phacoemulsification there was no clinical effect on final visual acuity.

Topical nepafenac 0.1% alone versus prednisolone acetate 1% as postoperative anti-inflammatory agents in small gauge vitrectomy.

Aim: To compare the effi cacy of postoperative topical nepafenac (0.1%) with prednisolone acetate (1%) as anti-infl ammatory agents in eyes undergoing Transscleral Sutureless Vitrectomy (TSV). Se􀄴 ings and Design: Prospective, double-blind, randomized, single center clinical study. Materials and Methods: Eighty eyes of 76 subjects, who underwent small gauge vitrectomy, were included in the study. The subjects who fulfi lled the inclusion criteria were randomized to either topical nepafenac only (Group 1) or prednisolone acetate only (Group 2), to be used as postoperative anti-infl ammatory agents. The subjects were reviewed on days 1, 30, and 90. Ocular and adnexal infl ammation was appropriately graded using the standardized classifi cation. Grading of ocular pain was done on the Visual Analog Scale (VAS). Statistical Analysis: The Wilcoxon rank-sum test, using two-sided analysis, was used. Results: During the follow-up, both Group 1 and Group 2 did not have a signifi cant diff erence related to the grade of the anterior chamber infl ammation (P > 0.05) or adnexal infl ammation (P > 0.05). Pain perception was less in the subjects in Group 1 as compared to subjects in Group 2, but was not statistically signifi cant (P > 0.05). Conclusion: Postoperative topical nepafenac was non-inferior to prednisolone acetate in reducing postoperative ocular infl ammation in eyes undergoing TSV.

Effect of topical ketorolac tromethamine and topical nepafenac on maintaining pupillary dilation during phacoemulsification

Objective@#This study compared the effectiveness of prophylactic administration of topical ketorolac tromethamine 0.5% and nepafenac 0.1% on maintaining mydriasis during phacomulsification.@*Methods@#This is a prospective, randomized, double-masked comparative study involving adult cataract patients given topical NSAIDs (ketorolac or nepafenac) or balanced salt solution (control) prior to phacoemulsification and capsular bag intraocular-lens (IOL) implantation at a tertiary hospital. Horizontal and vertical diameters of pupil were measured at different stages of cataract surgery and the mean values were compared across the three groups.@*Results@#A total of 47 eyes of 44 cataract surgery patients, 13 males and 34 females, with a mean age of 66.04 ± 8.87 years, were included in the study. The mean horizontal and vertical diameters of the three groups were similar at the start of surgery. Significant differences were seen after IOL implantation, with the nepafenac group having the largest mean diameters in both horizontal (p = 0.012) and vertical (p = 0.012) pupil measurements.@*Conclusion@#Topical nepafenac has been shown to be a more effective inhibitor of miosis during phacoemulsification and provides a more stable mydriatic effect throughout the surgical procedure compared to topical ketorolac and placebo.