Efficacy and safety of topical nepafenac in the prevention of macular oedema following cataract surgery in patients with diabetes: analysis of real-world data

Session Details

Session Title: Cataract Surgery & Retinal Complications

Session Date/Time: Tuesday 25/09/2018 | 16:30-18:00

Paper Time: 16:56

Venue: Room A3, Podium 1

First Author: : Y.Neo UK

Co Author(s): :    M. Theodorsson   D. Muhundhakumar   N. Lee   S. George           

Abstract Details

Purpose:

Diabetes (both type I and II) had been shown to be strongly associated with the incidence of post-operative macular oedema (MO) after cataract surgery. We sought to evaluate the efficacy and safety of 0.1% topical nepafenac in the prevention of MO after cataract operation following a 60 days protocol in a real-world clinical setting.

Setting:

Medical retina specialist clinic in a tertiary hospital setting (The Hillingdon Hospitals NHS Foundation Trust).

Methods:

A prospective cohort study was carried out on 350 adult diabetic patients with non-proliferative diabetic retinopathy who underwent uncomplicated phacoemulsification and intraocular lens insertion. Patients with pre-existing MO, retinal vein occlusion, vitreomacular disease, epiretinal membrane and concomitant use of steroids were excluded (n=65). Topical nepafenac instillation was carried out for 60 days. Efficacy measurement included incidence of MO (≥30% increase in central subfield macular thickness) and percentage of patients with decreases in best-corrected visual acuity (BCVA) >0.2logMAR. Outcome measures were compared head-to-head to results of two published clinical trials which adopted a 90 days protocol using the same drug.

Results:

Cumulative incidence of post-operative MO after one year is 13/285(4.6%).Mean time of development is 8.5±1.25days for mild to-moderate MO and 18.0±4.50days for severe MO. Risk factors included pre-proliferative diabetic retinopathy (RR12.8), hypertension (RR8.1) and previous diabetic macular oedema (RR5.6). 10/13(76.9%) of these MO resolved without intravitreal injection. There is no statistical difference in mean 60 days post-operative CSMT changes between results of our study and that in the two-other published clinical trials (p=0.66;95%CI0.45-0.96). BCVA decrease of more than 0.2logMAR is low on Day 14(4.2%), Day 30(3.2%) and Day 60(1.4%). There was no reported serious adverse events.

Conclusions:

0.1% topical nepafenac is safe and effective in prevention of MO after cataract surgery in patients with diabetes. 60 days topical nepafenac 0.1% treatment regimen gives comparable results to the intensive-trial-setting 90 days topical nepafenac 0.1% treatment protocol, in our day-to-day clinical setting.

Financial Disclosure:

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