Comparison of Bromfenac and Nepafenac for Prevention of Cystoid Macular Edema Following Phacoemulsification: A Multicenter Randomized Clinical Study

Abstract

Objective: To compare the efficacy, safety, treatment adherence, and direct medication cost of topical bromfenac and nepafenac for preventing cystoid macular edema following uncomplicated phacoemulsification.

Methods: This multicenter, assessor-masked, randomized clinical study was conducted over nine months at three tertiary-care ophthalmology departments in Pakistan. A total of 120 adults undergoing uncomplicated phacoemulsification were allocated equally to receive Bromfenac 0.09% twice daily or Nepafenac 0.1% three times daily. Both treatments were started one day before surgery and continued for four weeks postoperatively alongside identical corticosteroid and antibiotic therapy. Spectral-domain optical coherence tomography was performed before surgery and at postoperative weeks 1, 4, and 12. The primary outcome was change in central subfield thickness at four weeks. Secondary outcomes included optical coherence tomography-defined cystoid macular edema, corrected distance visual acuity, anterior chamber inflammation, adverse events, treatment adherence, and direct medication cost.

Results: The mean age of participants was 61.7±7.6 years and 64 (53.3%) were women. At four weeks, central subfield thickness increased by 10.8±13.7 µm in the bromfenac group and 13.9±16.2 µm in the nepafenac group (p=0.260). Cystoid macular edema occurred in 2 (3.3%) and 4 (6.7%) participants, respectively (p=0.679). Corrected distance visual acuity improved significantly in both groups, without a meaningful between-group difference. Adherence of at least 90% was achieved by 88.3% of bromfenac-treated and 73.3% of nepafenac-treated participants (p=0.037). No serious ocular adverse event was observed.

Conclusion: Bromfenac and Nepafenac provided comparable protection against cystoid macular edema following uncomplicated phacoemulsification. Bromfenac was associated with better treatment adherence and a lower modeled direct medication cost, making it a practical option in resource-constrained settings.