الفهرس 
Optical coherence tomographyOnly 14 pages are availabe for public view
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Abstract
Phacoemulsification with bagal intraocular lens (IOL) implantation is one of the well-known, commonly performed eye surgeries.
Even though there have been great advancements in the techniques used by ophthalmologists around the world to perform phacoemulsification efficiently and with the minimal possible postoperative complications, cystoid macular edema keeps its position as the number one suspect to be accused of any unfavorable visual results after uneventful phacoemulsification procedure with the studies suggesting a percentage ranging from 0% to 9%.
Cystoid macular edema shows itself in two forms, subclinical cystoid macular edema which doesn’t affect the vision but can be easily diagnosed using fluorescein angiography, appearing as a leakage from the perifoveal blood vessels. The other form is the clinical cystoid macular edema. It affects the visual acuity and clinically identified by a simple biomicroscopic fundus examination.
For decades, fluorescein angiography has been considered the gold standard investigation for diagnosis of cystoid macular edema though it was hard to quantify the fluorescein leakage. Recently, OCT has surpassed the effectiveness of fluorescein angiography in diagnosis of cystoid macular edema both quantitatively and qualitatively with its non-invasiveness favors its common use.
Cystoid macular edema following phacoemulsification is most commonly attributed to surgery-related blood-retinal barrier disruption caused by intra-surgical release of the inflammatory mediators called PGDs.
Corticosteroids and non-steroidal anti-inflammatory drugs are commonly used as an effective treatment for ocular inflammations being able to interfere with the arachidonic acid cascades ending by the formation of PGDs, the main factor incriminated for surgery-induced cystoid macular edema.
When we take into consideration the innumerable health side effects that associate corticosteroid use, non-steroidal anti-inflammatory drugs can win the race, surpassing the effectiveness of corticosteroids for that purpose, and be solicited as a first choice in managing ocular inflammations, being able to reduce the risk for secondary infection, stabilize the IOP, and induce an analgesic effect with much less associating complications than corticosteroids.
NSAIDs interfere with the activation of COX1 and COX2 enzymes preventing the final production of PGDs. Bromfenac is the most potent topical NSAID regarding its COX-2 inhibitory effect.
Our comparative prospective randomized double-blinded clinical trial was conducted at ophthalmic department of Menoufia University in th period between August 2018 and August 2019 and it 75 patients with senile cataract.
We studied the effectiveness of two types of topical NSAIDs, Bromfenac and Nepafenac, on minimizing the incidence of CME after phacoemulsification. Our study medications were given to patients two days before the scheduled surgery and continued for at least two months post-surgery. We followed patients for visual acuity, IOP, and OCT changes.
Prior to surgery, patients were thoroughly examined concerning taking a detailed medical history, visual acuity and IOP measurement, slit lamp biomicroscopy, and fundus examination.
Inclusion criteria involved patients with senile cataract who are 40 years or older and were scheduled for cataract extraction by phacoemulsification with bagal intraocular lens implantation under local anesthesia at the ophthalmology department, faculty of medicine, Menoufia University.
Exclusion criteria included: small pupils, patients with dark brown irises, ocular pathologies, patients under current treatment with any form of topical or systemic anti-inflammatory drugs, pregnant women, patients with hypersensitivity to any of the given study medications, and patients who suffered intraoperative complications.
Patients were randomly divided into 3 groups:
group І received tear substitute as a placebo.
group п received nepafenac 0.1% one DROP three times a day.
group ш received bromfenac 0.09% one DROP two times a day.
All patients had conventional phacoemulsification surgery with bagal IOL implantation. Patients in group І (control group) received topical corticosteroid antibiotic eye drops 4 times per day for one week and then tapered over the next 3 weeks. Patients in group п and ш started topical NSAIDs two days pre-surgery and continued study medications together with conventional topical corticosteroid therapy for two months postoperatively.
All cases were followed up for 3 months postoperatively at day 1, 1 week, 1 month, 2 months and 3 months. Each follow-up visit involved OCT scanning with the aim of investigating macular thickness changes. BCVA was checked for every case.
For all retinal thickness measurements, a significant increase in all three groups had been detected, starting from the first week post-operative. Compared with the control regimen, add-on Bromfenac or Nepafenac resulted in statistically significant minimizing the changes in the following parameters: Change in the macular volume and the central subfield thickness.
Bromfenac has statistically surpassed Nepafenac in minimizing the incidence of CME after uneventful phacoemulsification.