Nepafenac 0.1% successfully treats cystoid macular edema

Treatment with the topical nonsteroidal anti-inflammatory drug nepafenac 0.1% (Nevanac, Alcon Laboratories) with or without steroids resulted in improved visual acuity and macular edema in patients with acute pseudophakic, chronic/recalcitrant pseudophakic, and recalcitrant uveitic cystoid macular edema (CME), according to Seenu Hariprasad, MD.

Dr. Hariprasad and colleagues conducted a retrospective case study of 17 patients (19 eyes) treated with nepafenac given three times daily. Of these, two eyes had acute pseudophakic CME, 11 chronic/recalcitrant pseudophakic CME, and six recalcitrant CME secondary to uveitis.

Five of these patients also received prednisolone acetate 1%, said Dr. Hariprasad, assistant professor of ophthalmology and visual science, and director of clinical research, Vitreoretinal Service, University of Chicago.

In a patient with bilateral recalcitrant CME secondary to pars planitis, no change was seen following 8 months of treatment with prednisolone acetate 1% (Pred Forte, Allergan) and ketorolac tromethamine 0.5% (Acular, Allergan). Treatment with intravitreal triamcinolone acetonide (Kenalog, Bristol-Meyers Squibb) resulted in increased visual acuity and decreased retinal thickness but elevated IOP (56 mm Hg) in the left eye. Following treatment with nepafenac, the central retinal thickness decreased from 695 to 164 µm and the vision returned to 20/20.

With all types of CME, Dr. Hariprasad reported that the central retinal thickness decreased significantly. The mean retinal thickness of 456.9 µm before treatment decreased by an average of 207.8 µm. The visual acuity improved by an average of 0.34 logMAR, approximately 3.5 lines of Snellen visual acuity.

"The central retinal thickness decreased and the visual acuity increased in these patients with CME treated with nepafenac," he concluded. "The results of this study warrant further investigation of nepafenac 0.1% for CME in a randomized controlled trial."