Functional and Morphological Changes Following Macular Pucker Surgery After Topical Administration of Indomethacin 0.5%, Bromfenac 0.09%, Nepafenac 0.1%, or Placebo

Purpose : Nonsteroidal antiinflammatory drugs (NSAIDs) are reported to penetrate the vitreous and lower basal prostaglandin E2 level. We investigated the functional and morphological changes in patients treated with NSAIDs before vitrectomy for macular pucker.

Methods : A prospective, investigator-masked, randomized study was performed in 64 patients scheduled to undergo 25-gauge vitrectomy. The patients were randomized 1:1:1:1 to receive indomethacin 0.5%, bromfenac 0.09%, nepafenac 0.1%, or placebo three times a day one week before surgery. Main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) findings.

Results : Mean BCVA improvement was 0.24 ± 0.15 LogMAR for indomethacin, 0.26 ± 0.13 LogMAR for bromfenac, 0.23 ± 0.1 LogMAR for nepafenac, and 0.23 ± 0.1 LogMAR for placebo (P = 0.87). Mean CMT reduction was 50.2 ± 85 µm for indomethacin, 122.4 ± 63 µm for bromfenac, 65.6 ± 100 µm for nepafenac, and 117.2 ± 164.3 for placebo (P = 0.3). No statistical differences among the different NSAID groups were noticed in either BCVA or CMT.

Conclusions : Despite the antiinflammatory activity of the NSAIDs in the vitreous, no functional or morphological improvements were observed after macular pucker surgery.