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Study on efficacy of preoperative use of Flurbiprofen and Nepafenac eye drops in maintaining mydriasis during cataract surgery in comparison with duration of surgery in patients with senile cataract: A prospective randomized study

Ambati Divya, Nareddy Prasanna, Kiran Kumar Gudivada, Sreedhar Wudaru

Objective: Cataract surgery is the predominant procedure in day to day practice for many ophthalmologists. Maintaining appropriate mydriasis during surgery is the key for successful and safe surgery. Cataract surgery initiates the inflammatory cascade, thereby releasing prostaglandins. Prostaglandins lead to constriction of pupil during surgery. Topical NSAIDS are potent inhibitors of cyclooxygenase enzymes thereby inhibiting the biosynthesis of prostaglandins. Aim of the study is to compare the effectiveness of preoperative use of topical Nepafenac 0.1% and Flurbiprofen 0.03% eye drops in sustaining the mydriasis during surgery and comparison of efficacy of both in correlation with the duration of surgery.

Methods: We performed a Prospective, randomized, double blind, comparative study on 100 patients. Patients were randomly allocated into 2 equal groups to receive either Nepafenac or Flurbiprofen. Drug was allocated on the same day and prior to small incision cataract surgery. Pupil diameter was measured at the beginning and at the end of surgery and also duration of surgery was noted. The values of pupil diameter of both groups were compared and also with duration of surgery.

Results: A total of 100 eyes of cataract surgery patients, 46 males and 54 females with mean age group of 62.04 of were included in the study. The mean horizontal (p-value=0.404) and vertical (pvalue= 0.279) diameter of Nepafenac and Flurbiprofen groups were almost similar with no statistically significant difference at the beginning and end of the surgery. There is not a statistically significant difference in variance of mean difference in pupil diameter among different time intervals. But there is a statistically significant difference in variance in mean deviation among patients in Nepafenac group (p-value=0.0089).

Conclusion: Topical Nepafenac and Flurbiprofen are equally effective in maintaining mydriasis, but Nepafenac is more efficacious in maintaining mydriasis as the duration of surgery is increased.