Nepafenac 3mg/ml eye drops

The aim of this Network Meta-analysis was to compare the efficacy of the different topical Nonsteroidal anti-inflammatory drugs (NSAIDs) when added or not to topical steroids in preventing the thickening of the macula and their impact on visual acuity and intraocular pressure after phacoemulsification. Five electronic databases were searched, including PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov. Our primary outcome was one-month post-surgery visual outcome. We also considered change in Foveal thickness (FT) and Intraocular pressure (IOP) at one-month post-surgery. We summarized our analyses by calculating the mean differences (MD) with associated 95% confidence intervals (CI) using restricted maximum likelihood in random effects models for continuous outcomes. The methodological quality of the studies was assessed with Cochrane Collaboration's tool. The network meta-analysis was conducted using frequentist approach considering Nepafenac 0.1% as a reference medication. Eleven Randomized controlled trials (RCTs) including 2175 subjects were selected for quantitative analysis. At one-month post-surgery, Bromfenac had statistically significant better visual acuity compared to Nepafenac 0.1% (p < 0.001), regarding FT, Nepafenac 0.3% had the least increase in FT compared to Nepafenac 0.1% (p = 0.09), regarding IOP, Diclofenac had the lowest IOP. No significant results regarding FT and IOP. Interestingly Ketorolac had the worst results regarding BCVA and IOP, and came last but one for FT. Overall, our network meta-analysis demonstrated that Bromfenac was associated with a significant improvement in visual acuity compared to Nepafenac 0.1% at one-month following cataract surgery, while Nepafenac 0.3% was associated with the least increase in foveal thickness.

Abstract licence: CC BY

As a new ophthalmic non-steroidal anti-inflammatory drug (NSAID) with prodrug structure, Nepafenac was supposed to have a better efficacy than conventional NSAIDs both in patients’ tolerability and ocular inflammation associated with cataract surgery. However, many current studies reached contradictory conclusions on the superiority of Nepafenac over Ketorolac. The objective of our study is to evaluate the efficacy and patients’ tolerability of Nepafenac and Ketorolac following cataract surgery. To clarify this, we conducted a meta-analysis of randomized controlled trials. Eleven articles were included in this study. The dataset consisted of 1165 patients, including 1175 cataract surgeries. Among them, 574 patients were in the Nepafenac group and 591 in the Ketorolac group. Our analysis indicated that these two drugs were equally effective in controlling post cataract surgery ocular inflammation, reducing macular edema, achieving a better visual ability and maintaining intraoperative mydriasis during cataract surgery. However, Nepafenac was more effective than Ketorolac in reducing the incidence of postoperative conjunctival hyperemia and ocular discomfort. This meta-analysis indicated that topical Nepafenac is superior to Ketorolac in patients’ tolerability following cataract surgery. However, these two drugs are equally desirable in the management of anterior chamber inflammation, visual rehabilitation and intraoperative mydriasis. Given the limitations in our study, more researches with larger sample sizes and focused on more specific indicators such as peak aqueous concentrations of drugs or PEG2 levels are required to reach a firmer conclusion.

Abstract licence: CC BY 4.0

Abstract Background Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Although timely screening and treatment remain the cornerstone of management, specialist shortages, referral delays, geographic barriers, and unreliable follow-up continue to compromise care delivery in many settings. In response to these challenges, some clinicians have adopted off-label topical nonsteroidal anti-inflammatory drug prophylaxis for early-stage disease despite limited supporting evidence. This study compared real-world clinical outcomes associated with topical ketorolac or nepafenac prophylaxis for stage 1–2 ROP with those associated with standard screening and historical surveillance-only care. Methods This multicenter retrospective cohort study included preterm infants screened for ROP at 14 institutions in Colombia. Infants receiving ketorolac or nepafenac prophylaxis (2019–2025) were analyzed separately compared with a historical cohort managed with surveillance only (2011–2018). The same consulting retina specialist performed all examinations and made all treatment decisions. The primary outcome was progression to treatment-requiring ROP by 60 weeks postmenstrual age. Secondary outcomes included time to progression, time to regression without rescue treatment, retreatment, and number of ophthalmic follow-up visits. Results The final analysis cohort included 192 infants: 98 in the nepafenac group, 48 in the ketorolac group, and 46 in the historical comparison group. Progression to treatment-requiring ROP occurred in 20.83% of ketorolac-treated infants and 22.45% of nepafenac-treated infants, compared with 45.65% in the historical cohort (relative risk 0.46 [95% CI 0.24–0.86] and 0.49 [0.30–0.80], respectively; number needed to treat 4 for both). Both agents were associated with fewer follow-up visits and faster regression. After adjustment, ketorolac remained associated with lower odds of progression (odds ratio 0.28 [95% CI 0.09–0.87]). No major prophylaxis-related adverse effects were reported. Conclusions Prophylaxis showed a clinically relevant real-world signal in early-stage ROP, but the adjusted findings were more internally coherent for ketorolac. Randomized controlled trials are needed to determine efficacy, safety, and economic value.

Abstract licence: CC BY