Comparison of Preoperative Topical Nepafenac (0.1%), Flurbiprofen (0.03%) and Ketorolac (0.4%) Eye Drops in Maintaining Mydriasis During Phacoemulsification- A Randomised, Double-Blind Study

Abstract

BACKGROUND Phacoemulsification with IOL implantation is the current surgical treatment of choice for cataract extraction. Intraoperative manipulation during surgery triggers inflammatory cascade resulting in miosis, pain, inflammation or cystoid macular oedema. Adequate pupillary dilatation and its maintenance is required for proper anterior capsule incision and nucleus delivery and IOL implantation failing which may lead to complications. Aim-This study compares the effectiveness of prophylactic administration of topical flurbiprofen 0.03%, nepafenac 0.1% and ketorolac 0.4% in maintaining mydriasis during phacoemulsification with IOL implantation in the capsular bag. MATERIALS AND METHODS It is a prospective, randomised, double blind study involving 120 eyes undergoing phacoemulsification which were randomly and equally divided into four groups receiving topical nepafenac 0.1% (Group 1), flurbiprofen 0.03% (Group 2), ketorolac 0.4% (Group 3), placebo CMC 0.5% (Group 4) prior to the surgery. Pupil diameters were recorded at different stages of surgery and the mean value was compared. All the data was analysed with the software SPSS 20.0. Chi square test and ANOVA was used for comparison amongst the four groups. RESULTS Total 120 eyes were included, 50 females and 70 males of mean age 59.458 ± 8.74 years. The pupil diameter at the baseline was comparable in all four groups. Significant difference was seen in the pupil diameter in all the groups; however, nepafenac group had the least decrease in the pupil diameter at the end of surgery (P = 0.009). CONCLUSION Topical nepafenac has shown to be a potent inhibitor of miosis during phacoemulsification and also maintained the mydriasis throughout the procedure as compared to topical flurbiprofen, ketorolac and placebo.