Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Bora Yüksel, Ömer Karti, Tuncay Kusbeci Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey Abstract: Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent...

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Autores principales:	Yüksel B, Kartı Ö, Kusbeci T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Cataract surgery macular edema prevention nepafenac diabetic patients. Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/b5cb5fae89844692aad580d33487eb70
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spelling	oai:doaj.org-article:b5cb5fae89844692aad580d33487eb702021-12-02T07:09:23ZTopical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives1177-5483https://doaj.org/article/b5cb5fae89844692aad580d33487eb702017-12-01T00:00:00Zhttps://www.dovepress.com/topical-nepafenac-for-prevention-of-post-cataract-surgery-macular-edem-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Bora Yüksel, Ömer Karti, Tuncay Kusbeci Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey Abstract: Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery. Keywords: cataract surgery, macular edema, prevention, nepafenac, diabetic patientsYüksel BKartı ÖKusbeci TDove Medical PressarticleCataract surgerymacular edemapreventionnepafenacdiabetic patients.OphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 11, Pp 2183-2190 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cataract surgery macular edema prevention nepafenac diabetic patients. Ophthalmology RE1-994
spellingShingle	Cataract surgery macular edema prevention nepafenac diabetic patients. Ophthalmology RE1-994 Yüksel B Kartı Ö Kusbeci T Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
description	Bora Yüksel, Ömer Karti, Tuncay Kusbeci Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey Abstract: Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery. Keywords: cataract surgery, macular edema, prevention, nepafenac, diabetic patients
format	article
author	Yüksel B Kartı Ö Kusbeci T
author_facet	Yüksel B Kartı Ö Kusbeci T
author_sort	Yüksel B
title	Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
title_short	Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
title_full	Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
title_fullStr	Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
title_full_unstemmed	Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
title_sort	topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/b5cb5fae89844692aad580d33487eb70
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Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

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