Nepafenac 0.3% As A Steroid-Sparing Alternative To Prednisolone Acetate For Post-Phacoemulsification Inflammation: A Comparative Study

To compare the anti-inflammatory efficacy and safety of prednisolone acetate 1% versus nepafenac 0.3% in patients undergoing phacoemulsification with intraocular lens implantation (IOL), and to evaluate nepafenac as a steroid-sparing postoperative regimen.

Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan.

This prospective comparative study included patients undergoing uneventful phacoemulsification with IOL implantation between December 2023 and July 2024. Postoperatively, patients received either prednisolone acetate 1% or nepafenac 0.3%. Outcomes were assessed at 4 weeks. The primary endpoint was improvement in best-corrected visual acuity (BCVA), measured by reduction in logMAR values from baseline. Clinically significant improvement was defined as a ≥0.2 logMAR reduction. Secondary outcomes included anterior chamber inflammation graded by SUN criteria and incidence of adverse events.

A total of 324 patients were analyzed (mean age 64.77 ± 9.27 years). Mean logMAR improvement was 0.28 ± 0.11 in the prednisolone group and 0.30 ± 0.11 in the nepafenac group (p=0.050). Clinically significant visual improvement occurred in 121 (48.8%) patients in the prednisolone group and 127 (51.2%) in the nepafenac group. Distribution of anterior chamber inflammation grades (0, 1+, 2+, 3+) was comparable between groups. Overall, 76 (23.4%) adverse events were reported: 40 (52.6%) in the prednisolone group and 36 (47.4%) in the nepafenac group, with no serious complications.

Nepafenac 0.3% provides comparable anti-inflammatory control and visual outcomes to prednisolone acetate after phacoemulsification, with a favorable safety profile. It represents a safe and effective steroid-sparing alternative, especially valuable for patients at risk of steroid-induced intraocular pressure elevation.