Topical nepafenac efficacy is suggested by retrospective study

A retrospective study analyzed outcomes in 18 patients who were treated for idiopathic or post-cataract surgery cystoid macular edema with nepafenac 0.1% (Nevanac, Alcon Laboratories) alone or combined with a corticosteroid. Statistically significant improvements were achieved in mean visual acuity and foveal thickness in both groups.

Key Points

Yu-Guang He, MD, and Carolyn Chen, MD, identified a consecutive case series of patients, seen between January 2007 and December 2008, in whom idiopathic or pseudophakic CME was newly diagnosed and in whom initial treatment was with nepafenac alone or nepafenac in combination with a topical corticosteroid. Data were analyzed for 18 patients, including eight who received the nonsteroidal anti-inflammatory drug (NSAID) alone and 10 who were treated concomitantly with a topical corticosteroid. Dosing regimens and treatment durations varied, but after an average of 9.4 weeks of treatment, the group had statistically significant improvements in both mean visual acuity (2.1 Snellen lines) and foveal thickness (–129 µm).

Converted in eye

Nepafenac is a prodrug that is converted in the eye into the potent NSAID amfenac. Previous studies have shown that nepafenac rapidly and effectively penetrates the cornea and achieves higher intraocular concentrations compared with other topical NSAIDs, including in the retina.

"Results from rabbit studies also show that topically applied nepafenac was effective in reducing retinal edema and inflammatory mediator concentrations," Dr. He said.

The 18 patients in the retrospective study were composed of three patients who had idiopathic CME and 15 patients with post-cataract surgery CME. Nine of the 10 patients treated with a corticosteroid received prednisolone acetate 1% (Pred Forte, Allergan), and one was treated with loteprednol etabonate 0.5% (Lotemax, Bausch & Lomb). Dosing regimens for nepafenac ranged from two to four times daily, prednisolone acetate was administered between two and six times daily, and the one patient treated with loteprednol used that corticosteroid twice daily. Total treatment duration ranged from 2 to 24 weeks.

Pre-treatment foveal retinal nerve fiber layer thickness averaged 384 µm and decreased to 255 µm. Mean visual acuity improved from 20/82 pre-treatment to 20/43. A single patient lost one line of vision, and no patient lost more than one line.

The investigators acknowledged that patient selection bias may have existed in their retrospective study. In addition, it included a small number of patients who received variable dosing regimens of nepafenac, and it did not account for either the effect of the concomitant corticosteroid or the natural history of CME, which may resolve spontaneously.