A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery

Postoperative inflammation and cystoid macular edema (CME) are common challenges following phacoemulsification that may impair visual recovery if not adequately controlled. This prospective, randomized study involving 600 patients compared the efficacy and safety of three anti-inflammatory regimens after uneventful phacoemulsification with IOL implantation: nepafenac 0.3% once daily (Group A), nepafenac 0.1% three times daily (Group B), and loteprednol etabonate 0.5% three times daily (Group C) for 6 weeks. Anterior chamber cells, pain (VAS), conjunctival hyperemia, IOP, and central macular thickness (CMT) on SD-OCT were assessed at weeks 1 and 6. At week 6, Group A demonstrated significantly fewer anterior chamber cells (p = 0.03), lower pain scores (p = 0.04), and the smallest increase in CMT (7.1 ± 3.2 µm versus 13.4 ± 4.7 µm in Group B and 15.6 ± 5.1 µm in Group C; p < 0.001), while the loteprednol group exhibited the highest IOP (17.2 ± 2.5 mmHg; p < 0.001), with no significant intergroup differences in conjunctival hyperemia. Once-daily nepafenac 0.3% therefore proved superior to both nepafenac 0.1% TID and loteprednol 0.5% TID in controlling postoperative inflammation and pain, preventing CME, and avoiding steroid-induced IOP rise, while providing the added benefit of better patient compliance through a simpler dosing schedule.