Role Of Nepafenac On Changes In Central Macular Thickness In Diabetic Eyes Undergoing Cataract Study- A Prospective Comparative Study

The purpose of this study is to evaluate the role of prophylactic topical non-steroidal anti-inflammatory drugs( NSAIDS-Nepafenac) eyedrops on the central macular thickness (CMT)and total macular volume (TMV) in the diabetic eyes undergoing manual small incision cataract surgery(SICS).

Cataract surgery is among most common cause of Cystoid Macular Edema( CME) ranging from 1% to 30% and if there are pre-operative problems like diabetic retinopathy, frequency rises. Thus it is necessary to search for a preventive measure to decrease incidence of CME. NSAIDs main action is to block cyclo-oxygenase enzymes responsible for prostaglandin synthesis. Despite this, previous studies have not come into consensus on prophylactic usage of NSAID eyedrops in prevention of pseudophakic CME.

The study was conducted in a tertiary care center from February 2021 to June 2022. Study sample included 80 diabetic eyes undergoing manual small incision cataract surgery. Pre-operatively CMT and TMV was measured using Optical Coherence Tomography (OCT) along with best corrected visual acuity( BCVA). Then all eyes underwent manual SICS. Post-operatively study sample was divided into 2 groups. Both the groups received conventional topical antibiotic steroid eyedrops, Alongwith this only Group A received topical Nepafenac eyedrops. Post-operatively CMT, TMV and BCVA were measured on post-operative day 7, 38 and 90. Statistical analysis were done to compare the change in variables between the 2 groups. 

The mean age in Group A was 60.93+/-5.86 years and in Group B was 58.53+/-7.41 years.

28(70%) were males and 12(30%) were females in Group A. 23(57.5%) were males and 17(42.5%) were females in Group B. Mean duration of Diabetes Mellitus in Group A was 4.83+/-2.53 years and in Group B was 3.96+/-2.9 years.

Comparative assessment of change in BCVA, CMT and TMV amongst the two groups showed no significant difference statistically showing BCVA, CMT and TMV attained at all stages were comparable in amongst 2 groups. The p values of change in BCVA, CMT and TMV when compared amongst 2 groups showed 0.410, 0.5691 and 0.7548 ( p value <0.05 was taken as significant) suggesting no significant difference statistically amongst two groups.

There is no role of topical NSAIDs given post cataract surgery for prevention of pseudophakic CME. Change in BCVA isn’t affected by the topical NSAIDS when given in the post-operative period. Change in TMV isn’t affected by the topical NSAIDS when given in the post-operative period. There is no linear correlation between the best corrected visual acuity and Central Macular thickness following cataract surgery in the diabetic eyes. Combined usage of both topical antibiotic steroid eye drops with topical NSAIDs have no beneficial role in curtailing the CMT and TMV rise post cataract surgery in the diabetic eyes. Thus the additional burden on patients with nepafenac eyedrops has no role in prevention of Pseudophakic CME