A comparative study on efficacy of nepafenac and flurbiprofen in maintenance of intraoperative mydriasis during cataract surgery: an open label randomized controlled trial
Keywords:Cataract surgery, Flurbiprofen, Intraoperative mydriasis, Nepafenac
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’s 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’s 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±0.71mm in the Nepafenac group and 1.77±0.72mm 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.
Gogate PM, Deshpande M, Wormald RP, Deshpande R, Kulkarni SR. Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India: a randomized controlled trial. Br J Ophthalmol 2003;87:667-72.
Bansal G, Gupta S, Kumar S, Kansal S. Comparison of The Effect of Topical Bromfenac With Nepafenac in Maintaining Mydriasis During Cataract Surgery. Delhi J Ophthalmol. 2015;26:97-100.
Garg A, Pandey SK, Fry LL, Gutierrez FJ, Tabin G. Clinical Practice in Small Incision Cataract Surgery Phaco Manual, 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. 2004. Clinical Practice in Small Incision Cataract Surgery Phaco Manual.
Colin J. The Role of NSAIDs in the Management of postoperative ophthalmic Inflammation. Drugs. 2007;67(9):1291-308.
Koay P. The emerging roles of topical non-steroidal anti-inflammatory agents in ophthalmology. Br J Ophthalmol. 1996;80(5):480-5.
Papa V, Russo S, Russo P, Di Bella A, Santocono M, Milazzo G. Naproxen Study Group. Topical naproxen sodium for inhibition of miosis during cataract surgery. Prospective, randomized clinical trials. Eye (Lond). 2002;16(3):292-6.
Podos SM. Prostaglandins, nonsteroidal anti-inflammatory agents and eye disease. Trans Am Ophthalmol Soc. 1976;74:637-60.
Bannale SG, Pundarikaksha HP, Sowbhagya HN. A Prospective, Open-label Study to Compare the Efficacy and the Safety of Topical Loteprednol Etabonate and Topical Flurbiprofen Sodium in Patients with Post-Operative Inflammation after Cataract Extraction. J Clin Diagn Res. 2012;6(9):1499-503.
Sarkar S, Mondal KK, Roy SS, Gayen S, Ghosh A, De RR. Comparison of preoperative nepafenac (0.1%) and flurbiprofen (0.03%) eye drops in maintaining mydriasis during small incision cataract surgery in patients with senile cataract: A randomized, double-blind study. Indian J Pharmacol. 2015;47:491-5.
Rajanandh MG, Ramasamy C, Raj KM. Individual and additive mydriatic effect of tropicamide with phenylephrine and flurbiprofen in diabetic patients. Eur J Appl Sci. 2012;4:98-100.
Sharma AK, Sharma HR, Sharma R, Singh A. A Comparison of Preoperative Topical Dexamethasone Phosphate Versus Ketorolac Tromethamine in Maintaining Intraoperative Mydriasis During Small Incision Cataract Surgery. J Clin Diagn Res. 2016;10(5):NC09-13.
Zanetti FR, Fulco EA, Chaves FR, da Costa Pinto AP, Arieta CE, Lira RP. Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial. Indian J Ophthalmol. 2012;60:277-81.
Roberts CW. Comparison of diclofenac sodium and flurbiprofen for inhibition of surgically induced miosis. J Cataract Refract Surg.1996;22:780-87.
O’Brien TP. Emerging guidelines for use of NSAID therapy to optimize cataract surgery patient care. Curr Med Res Opin. 2005;21:1131-7.
Atanis R, Tuaño PM, Vicencio J, Martinez JM, Verzosa L. Effect of topical ketorolac tromethamine and topical nepafenac on maintaining pupillary dilation during phacoemulsification. Philipp J Ophthalmol. 2011;36:23-7.
Gimbel H, Van Westenbrugge J, Cheetham JK, DeGryse R, Garcia CG. Intraocular Availability and Pupillary Effect of Flurbiprofen and Indomethacin During Cataract Surgery. J Cataract Refract Surg. 1996;22(4):474-9.
Cervantes-Coste G, Sanchez-Castro YG, Orozco-Carroll M, Mendoza- Schuster E, Velasco- Barona C. Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac. Clin Ophthalmol. 2009;3:219-26.
Surhio SA, Memon M, Talpur R, Talpur KI. Efficacy of nepafenac 0.1% in maintaining mydriasis during phaco emulsification surgery. JLUMHS. 2013;12:74-8.