Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.

Cystoid macular edema (CME), a common complication following cataract surgery, is routinely medically treated with topical nonsteroidal anti-inflammatory drugs (NSAIDs), alone or in combination with steroids. In this paper, we describe 6 patients with CME and 1 patient with diabetic macular edema (DME), all of whom were treated with nepafenac 0.1%, a novel prodrug NSAID. Three (3) patients with acute CME following cataract surgery were treated for 3-4 weeks with nepafenac 0.1%, with or without concomitant steroids. Both retinal thickness and visual acuity improved in all 3 cases. The 3 patients with chronic CME, each of whom had been previously treated with steroids with or without concomitant NSAID therapy, were started on nepafenac 0.1% three times daily. Retinal thickness and visual acuity improved in each case, except for 1 patient with 20/25 pretreatment visual acuity. The mean improvement in visual acuity of all 6 CME patients was 2.5 lines and the mean decrease in retinal thickness was 282.8 microm. The patient with DME also showed improvement in retinal thickness and visual acuity after 6 months of treatment with nepafenac. These clinical data strongly suggest that nepafenac 0.1% is a promising drug for the treatment of posterior segment inflammation, including CME, and warrants further investigation.

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