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Topical Nepafenac For Prevention Of Post-cataract Surgery Macular Edema In Diabetic Patients: Patient Selection And Perspectives

Bora Yüksel, Ömer Kartı, T. Kusbeci
Published 2017 · Medicine

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Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery.
This paper references
Effect of topical nepafenac in prevention of macular edema after cataract surgery in patients with non-proliferative diabetic retinopathy
Muhammad Haroon Sarfraz (2017)
Management of macular oedema in diabetic patients undergoing cataract surgery
F. Boscia (2017)
Inflammation-Mediated Retinal Edema in the Rabbit Is Inhibited by Topical Nepafenac
M. Kapin (2004)
Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery.
Blanche X Lim (2016)
Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery
J. R. Do (2015)
Prophylactic nepafenac and ketorolac versus placebo in preventing postoperative macular edema after uneventful phacoemulsification
D. Almeida (2012)
Topical drug delivery to the posterior segment of the eye: anatomical and physiological considerations.
T. Loftsson (2008)
Topical Nonsteroidal Anti-inflammatory Drugs and Cataract Surgery: A Report by the American Academy of Ophthalmology.
S. Kim (2015)
Cystoid macular edema associated with preservative-free latanoprost after uncomplicated cataract surgery: case report and review of the literature
O. Makri (2017)
Effect of preoperative topical diclofenac on intraocular interleukin-12 concentration and macular edema after cataract surgery in patients with diabetic retinopathy: a randomized controlled trial
Aleksej Medić (2017)
Comparison of Subtenon Triamcinolone Acetonide Injection with Topical Nepafenac for the Treatment of Pseudophakic Cystoid Macular Edema
Bora Yüksel (2017)
Treatment costs of cystoid macular edema among patients following cataract surgery
J. Schmier (2016)
Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal antiinflammatory eye drops: a systematic review. Ophthalmology
L Kessel (2014)
Treatment of cystoid macular edema after cataract surgery.
Laura H P Wielders (2017)
Corneal Epithelial Barrier Function in Diabetic Patients
M. Gekka (2004)
Differentiation of Diabetic Macular Edema From Pseudophakic Cystoid Macular Edema by Spectral-Domain Optical Coherence Tomography.
Marion R Munk (2015)
Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema.
J. M. B. Garcia (2016)
A newly defined vitreous syndrome following cataract surgery.
S. Irvine (1953)
Topical and systemic absorption in delivery of dexamethasone to the anterior and posterior segments of the eye.
H. Sigurdsson (2007)
Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo
S. McCafferty (2017)
Perioperative Topical Nonsteroidal Anti-inflammatory Drugs for Macular Edema Prophylaxis Following Cataract Surgery.
A. Grzybowski (2017)
Cystoid and diabetic macular edema treated with nepafenac 0.1%.
S. Hariprasad (2007)
In vivo assessment of corneal endothelial function in diabetes mellitus.
J. S. Saini (1996)
Distribution of topical ocular nepafenac and its active metabolite amfenac to the posterior segment of the eye.
James E. Chastain (2016)
Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery.
Neal H. Shorstein (2015)
Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients.
J. Yang (2017)
Intravitreal ketorolac for the treatment of chronic cystoid macular edema after cataract surgery
M. Tsilimbaris (2016)
Prospective randomised clinical trial to evaluate the safety and efficacy of nepafenac 0.1% treatment for the prevention of macular oedema associated with cataract surgery in patients with diabetic retinopathy
A. Pollack (2016)
Prospective, Randomized Study Comparing the Effect of 0.1% Nepafenac and 0.4% Ketorolac Tromethamine on Macular Thickness in Cataract Surgery Patients With Low Risk for Cystoid Macular Edema
Seema Ramakrishnan (2015)
Topical nonsteroidal anti-inflammatory drugs as adjuvant therapy in the prevention of macular edema after cataract surgery
N. Cardascia (2016)
Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study
P. F. Tzelikis (2014)
Nepafenac 0.3% after Cataract Surgery in Patients with Diabetic Retinopathy: Results of 2 Randomized Phase 3 Studies.
R. Singh (2017)
Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy
R. Singh (2012)
Risk Factors and Incidence of Macular Edema after Cataract Surgery: A Database Study of 81984 Eyes.
C. Chu (2016)
Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema
K. C. Mathys (2010)
A Case of Acute Bilateral Irvine-Gass Syndrome following Uncomplicated Phacoemulsification, Demonstrated with Optical Coherence Tomography
M. K. Shields (2015)
Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review.
L. Kessel (2014)
Once‐daily nepafenac ophthalmic suspension 0.3% to prevent and treat ocular inflammation and pain after cataract surgery: Phase 3 study
Satish S. Modi (2014)
United Kingdom Pseudophakic Macular Edema Study Group. Risk factors and incidence of macular edema after cataract surgery: a database study
CJ Chu (1984)
Macular edema after cataract surgery in diabetic eyes evaluated by optical coherence tomography.
X. Chen (2016)

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