Eyeworld

EW CATARACT 34 July 2017 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer previous retinal surgery," Dr. McCaf- ferty said, adding that in previous prospective studies all such condi- tions have been excluded. Studying nepafenac for PCME Study participants were randomized to receive either nepafenac 0.3% in a blinded bottle or placebo. When investigators examined results, they found that there was some impact of the drug on the condition. "What we found was that if physicians use NSAIDs on every single patient, there was a statistically significant reduced incidence of PCME," he said. "We found that to an even greater degree in patients with risk factors, the use of the NSAID greatly reduced the incidence of PCME." While this was determined to be well beyond anything that was statistically significant, when they excluded those with risk factors for PCME there was no statistical signif- icance found between the two arms, Dr. McCafferty continued. "If you were to blanket NSAID use, you would get some benefit to it as far as PCME," he said, adding, The drugs can be expensive, and Dr. McCafferty wanted to find out if they were actually helping prevent CME. "They can run more than $200 for the patients," he said. "Our question was, 'Are we helping patients out with these?'" To determine this, investigators launched a study of about 1,000 patients. This was four to five times larger than any study that had been done prospectively in this manner, Dr. McCafferty said. While there were several other NSAIDs available, investigators confined the investiga- tion to one agent. "There were sev- eral of them that were potentials for this but we determined that they all had the same mechanism of action," Dr. McCafferty said. So investigators came up with once daily nepafenac 0.3% as the drug that they would use in the double-blind trial. Patients with all risk factors for PCME were included here. "Those risk factors included anyone who had contralateral PCME, active diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, or prostaglandin use in inflammation—I use it off-label." To determine if his colleagues were doing the same, Dr. McCafferty ran an informal study in which he surveyed 62 cataract surgeons. "We found that 72% of them used the NSAID, not just nepafenac but any NSAID, primarily to prevent PCME," Dr. McCafferty said. "They may use it for pain and inflammation as well, but the primary purpose was to use it off-label to prevent cystoid macu- lar edema," he said. With that in mind, in the recent study, Dr. McCafferty wanted to de- termine whether such NSAIDs were effective for this purpose. "We had been using nepafenac and several others before for this purpose. There was this paucity of information as to whether or not it works for the primary reason that the general ophthalmologist uses it," he said. Previous studies had trended in that direction but were limited. "Small, sample size-controlled prospec- tive studies said that there was no benefit," Dr. McCafferty said. "The problem is they excluded the risk factors." Effective against CME in patients with risk factors W hen attempting to stave off pseudopha- kic cystoid macular edema (PCME), prac- titioners often reach for an NSAID. But is this likely to be effective? In a recent study, investi- gators determined that the topical NSAID nepafenac 0.3% (Nevanac 0.3%, Alcon, Fort Worth, Texas) was only effective against CME in those with preoperative risk factors for the condition, 1 according to Sean McCafferty, MD, Arizona Eye Consultants, Tucson, Arizona. While nepafenac and other NSAIDs are FDA approved for fight- ing inflammation in the anterior chamber and reducing pain in the first few days after surgery, that's not what many surgeons rely on them for, Dr. McCafferty finds. "I've been doing this for 20 years, and the predominant reason that I've used topical NSAIDs is to prevent PCME," he said. "I don't use it much for the Nepafenac to fight off CME Pseudophakic cystoid macular edema (PCME) OCT images Source: Sean McCafferty, MD

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