Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of CMO after phacoemulsification
Reviewed by Jonathan Chan

This is a prospective randomised clinical trial study including patients older than 40 years with age related cataract and normal ophthalmic examination. The patients are randomised into three different groups and the objective of the study is to compare the anti-inflammatory response and anti-inflammatory efficacy of ketorolac 0.4% and nepafenac 0.1% eye drops for prophylaxis of cystoid macular oedema (CMO) after small incision cataract surgery. Group 1 patients received a topical artificial tears substitute (placebo); group 2 received ketorolac 0.4% and group 3 received nepafenac 0.1%. The incident and severity of CMO were evaluated by retinal foveal thickness on optical coherence tomography (OCT) after one, four and 12 weeks duration. All the surgeries were performed in a standard way by a single surgeon and clear corneal temporal incision and a foldable posterior chamber lens implant was implanted into the capsular bag (Acrysof SN60WF, Alcon Surgical). No lidocaine or antibiotics were used during the procedure. Results: One hundred and twenty-six patients were randomised in this trial. The group differences between central corneal thickness and endothelial density were not statistically significant. In all retinal thickness measurements, an increase was detected in from the postoperative first until 12 weeks. There was no statistically significant difference between the three study groups in any measurement performed by spectral domain OCT. The authors conclude that non-steroidal anti-inflammatory drops used prophylactically after uneventful cataract surgery were not efficacious in preventing macular oedema compared with placebo. They recommended that larger study samples are necessary to better define the associations. The limitations of this study included the small size of the placebo group. 

Comparison of ketorolac 0.4% and nepafenac 0.1% for the prevention of cystoid macular oedema after phacoemulsification: prospective placebo-controlled randomised study.
Tzelikis PF, Viera M, Hida WT et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2015;99:654-8.