Effect of Adjunctive Topical Nepafenac on Early Inflammation after Cataract Surgery: A Multicenter Study

Abstract

Objective: To assess whether adding topical nepafenac 0.1% to postoperative corticosteroid treatment improved control of inflammation after uncomplicated cataract surgery.

Methods: This multicenter comparative study was conducted at three tertiary care hospitals in Punjab, Pakistan, from January to June 2025. Adults undergoing uncomplicated phacoemulsification received nepafenac 0.1% three times daily plus prednisolone acetate 1%, or prednisolone acetate 1% alone, for four weeks. The primary outcome was the proportion of eyes with no anterior chamber cells on postoperative day 7. Anterior chamber flare, pain, corrected distance visual acuity, central macular thickness and adverse events were also assessed.

Results: Of 240 patients, 120 received each regimen. On day 7, anterior chamber cells had resolved in 83 patients (69.2%) receiving nepafenac and 65 (54.2%) receiving corticosteroid alone. The absolute difference was 15.0 percentage points (95% confidence interval, 2.8–27.2; p=0.018). Mean cell grade and pain score were also lower in the nepafenac group. By day 28, inflammation had resolved in most eyes in both groups. Visual acuity and central macular thickness did not differ significantly. No serious treatment-related ocular event was recorded.

Conclusion: Adjunctive nepafenac improved control of anterior chamber inflammation during the first postoperative week. The difference between regimens was smaller at four weeks, when recovery was favorable in both groups.