Eyeworld

EW RESIDENTS September 2011 75 significance of the comparison. For the clinician who currently uses prednisolone acetate or an alternate NSAID for CME prophylaxis, demonstrating the superiority of nepafenac over FML is unlikely to provide clinically relevant informa- tion. Additionally, while the exten- sive exclusion criteria help free the study from confounders, the data generated should not be generalized to these patient populations, many of which are traditionally thought of as higher risk for developing CME and likely to benefit from medical prophylaxis. Finally, it is worth not- ing that the lead and senior authors are consultants of Alcon (Fort Worth, Texas), the producer of nepafenac, a relationship that may introduce bias. This study seeks to build on the existing literature by assessing the efficacy of a relatively new topical NSAID as prophylaxis against CME by quantifying CME, intraocular in- flammation, and its effect on visual acuity. While multiple studies have demonstrated the efficacy of other topical NSAIDs in reducing the inci- dence of post-op angiographic CME, the clinical implications of these findings have remained unclear. A recent review by Kim et al. found only one double-masked, random- ized, placebo-controlled study demonstrating an improvement in post-op Snellen visual acuity for pa- tients undergoing intracapsular cataract extraction and receiving an older generation topical NSAID (1% indomethacin in sesame oil; prepa- ration no longer available). How- ever, this benefit was not sustained beyond 3 months, and both groups also received corticosteroid medica- tions. Wolf et al. published a retrospective review comparing prednisolone to combination pred- nisolone and nepafenac for post-op CME and found that the nepafenac combination group showed a re- duced incidence of CME as evalu- ated by OCT. However, visual acuity data were not reported. Though not referenced in the Miyake paper, Mathys and Cohen published a ran- domized, prospective study compar- ing prednisolone to combination prednisolone and nepafenac in post- op CME prophylaxis and found no differences in retinal thickness on OCT or post-op visual acuities with no correlation between retinal thick- ness and vision in either group. Here, Miyake et al. provided data suggesting control of inflammation, retinal thickening, and angiographic CME with nepafenac, but questions regarding the impact on visual acu- ity persist. In summary, this study provides compelling evidence that nepafenac reduces post-op intraocular inflam- mation and angiographic CME when compared to FML. However, the aforementioned limitations pre- vent it from conclusively demon- strating an impact on vision or superiority to commonly used med- ications, and these limitations are important as they speak directly to the clinical importance of the study. Further work to elucidate the mech- anisms of post-op CME and the pro- phylactic role of nepafenac and other NSAIDs is needed. EW References Kim SF, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol 2010;55:108-33. Lichter P. Debunking myths in physician-in- dustry conflicts of interest. Am J Ophthalmol 2008;146:159–71. Mathys KC, Cohen KL. Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema. Eye 2010; 24(1):90-6. Miyake K, Sakamura S, Miura H. Long-term follow-up study on prevention of aphakic cys- toid macular oedema by topical indomethacin. Br J Ophthalmol 1980;64:324-8. Wolf EJ, Braunstein A, Shih C, Braunstein RE. Incidence of visually significant pseudophakic macular edema after uneventful phacoemulsi- fication in patients treated with nepafenac. J Cataract Refract Surg 2007; 33:1546-9. Contact information Naseri: ayman.naseri@va.gov 0.1% nepafenac and 0.1% fluorometholone cataract surgery" Resident MD membership application Click on the QR codes to access: the ASCRS Resident MD membership application form and the ASCRS webinars page View Webinars

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