'Nepafenac may reduce macular volume

Key Points

Cincinnati-Use of nepafenac (Nevanac, Alcon Laboratories), a topical nonsteroidal anti-inflammatory drug (NSAID), may decrease macular volume more rapidly after surgery to repair epiretinal membranes (ERMs).

A pilot study indicated that the central subfield macular thickness decreased by 10% and that the macular volume decreased about 5% 3 months postoperatively, according to Daniel M. Miller, MD, PhD. The drug was also found to have a good safety profile.

"The purpose of this study was to investigate the effects of nepafenac in patients undergoing ERM repair," he said. "Specifically, we were interested in whether nepafenac-treated patients experienced a more rapid reduction in macular volume and central subfield thickness postoperatively."

More rapid reduction?

Dr. Miller and colleagues designed a single-center, randomized, prospective, double-blinded study to determine if application of topical nepafenac provides a more rapid reduction in macular volume after vitrectomy surgery for ERMs compared with placebo.

The study included 40 patients who had visually relevant ERMs and a central subfield macular thickness that exceeded 300 µm on spectral-domain optical coherence tomography (SD-OCT [Cirrus HD-OCT, Carl Zeiss Meditec]). All patients underwent 25-gauge pars plana vitrectomy, peeling of the ERM, and peeling of the internal limiting membrane using indocyanine green.

Patients were randomly assigned to either the placebo group that received balanced saline solution T.I.D. beginning 1 day preoperatively to 3 months postoperatively or the nepafenac group that also received the drug T.I.D. beginning 1 day preoperatively to 3 months postoperatively.

Postoperatively, the patients in both groups received moxifloxacin (Vigamox, Alcon Laboratories) T.I.D. for 7 days and prednisolone acetate 1% (Omnipred, Alcon) Q.I.D. tapered over 4 weeks.