Nepafenac role in macular swelling prevention and in visual outcome after cataract surgery - a systematic review and meta-analysis.

Purpose: To compare Nepafenac effect on foveal thickness (FT), total macular volume (TMV), and BCVA after cataract surgery when added to the common regimen of topical steroids perioperatively.

Methods: PubMed, Scopus, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched systematically on April 28, 2022, for RCTs. Our primary outcome was the change in FT at final follow-up visits. We also considered FT at different follow-up durations, TMV, and visual outcome. We summarized our analyses by calculating the mean differences (MD) with associated 95% confidence intervals (CI) using restricted maximum likelihood in random effects models for continuous outcomes. The individual trials were evaluated for quality utilizing the Cochrane Collaboration's risk of bias assessment tool.

Results: Twenty-four RCTs totaling 4716 eyes were eligible. A significant difference was found between Nepafenac group and control group in the change in FT at final follow-up visit (MD, -11.622; 95% Cl [-17.475, -5.769]), at one week follow-up visit (MD, -6.409; 95% Cl [-13.148, 0.330]), at one month follow-up visit (MD, -9.090; 95% Cl [-13.260, -4.919]), at two months (MD, -5.769; 95% Cl (-22.477, -10.939]), and at three-month follow-up visit (MD, -12.913; 95% Cl [-22.254, -3.572]). However, there was no significant difference between the two groups regarding change in TMV at final follow-up visit. Nevertheless, a significant difference was found between the two groups regarding post-operative BCVA only at three-month follow-up visit.

Conclusion: Topical Nepafenac in addition to topical steroid is superior to the common regimen of topical steroid alone perioperatively in the prevention of macular swelling.