Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab

Abstract

Purpose: To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. Patients and methods: A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. Results: The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group ( p = 0.017), Ranibizumab and Control groups ( p = 0.009) with no significant difference between Nepafenac and Ranibizumab group ( p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control ( p = 0.001) and intravitreal Ranibizumab/control ( p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. Conclusion: Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.

Effect of ranibizumab combined with laser photocoagulation in the treatment of diabetic macular edema

“…Our study showed that the combined ranibizumab/ laser photocoagulation therapy has high application value and is superior to ranibizumab and laser monotherapies. Combined treatment is more effective in alleviating clinical symptoms, improving visual acuity, and reducing the occurrence of complications in patients with DME, which is basically consistent with Ishibashi et al 12 , Berger et al 13 , and Mitchell et al 14 Howaidy et al 10 used laser therapy and ranibizumab to treat patients with DME on the basis of routine intervention, and showed that it can effectively reduce the thickness of the macular fovea and prevent the occurrence of related complications, which is consistent with the results of our study. Ranibizumab has numerous advantages such as strong specificity, high bioavailability, and strong permeability, and can effectively inhibit VEGF in the retina, prevent vascular leakage, and reduce retinal edema.…”

“…As a result, the retina is in a dry state, which provides ideal conditions for laser photocoagulation treatment, ensures good spot response under low laser energy state, and reduces the occurrence of bleeding and other related complications. 10,15,16 Mi et al 11 also confirmed that the combination of ranibizumab and micro pulse laser therapy can reduce the number of anti-VEGF drug injections and relieve the pain and psychological burden of patients.…”

“…7,8 Ranibizumab is a second-generation humanized recombinant monoclonal antibody fragment against VEGF, which can selectively bind to VEGF and inhibit endothelial cell proliferation, thereby exerting therapeutic effects. 9,10 Several studies have suggested the superiority of combining laser treatment with anti-VEGF therapy in patients with DME. 5,11 However, most studies only compared the combined therapy with LP alone or ranibizumab alone, and few studies compared all three simultaneously.…”

Prophylactic interventions for preventing macular edema after cataract surgery in patients with diabetes: A Bayesian network meta-analysis of randomized controlled trials

“…In all, a total of 2566 participants from 17 randomized controlled trials were included in the finally network meta-analysis ( Table 1 and Supplementary Table 1). 9 , 10 , 13 , 14 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 17 studies reported 5 perioperative interventions: topical steroid eye drop, topical NSAIDs eye drop, intravitreal anti-VEGF agents injection, intravitreal steroid injection, and sub-tenon steroid injection. All studies used no intervention or topical steroid eye drop alone (None/Topical Steroids) as reference treatments.…”

Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications

“…The safety and efficacy of topical nepafenac 0.1% were tested in 6 eyes of 5 patients with DME, which showed that topical nepafenac treatment improved vision and decreased retinal thickness [ 211 ]. Postoperative topical nepafenac was shown to be effective for prophylaxis of macular edema in diabetic patients underwent phacoemulsification and intraocular lens implantation [ 212 ]. Further investigations on whether topical NSAIDs could serve as an alternative or adjunctive treatment to intravitreal anti-VEGF therapy are required.…”