COMPARISON BETWEEN TOPICAL NEPAFENAC AND FLURBIPROFEN IN MAINTAINING INTRAOPERATIVE MYDRIASIS AND CONTROLLING POSTOPERATVE INFLAMMATION IN CATARACT SURGERY

Abstract

NEED FOR THE STUDY:Preoperative dilation of pupil is one of the requisites for performing an uncomplicated cataract surgery. Intraoperative miosis is one the many challenges which a surgeon can encounter during cataract surgery. Routinely tropicamide with phenylephrine is used for preoperative dilatation of pupil,but intraoperative miosis is the complication.Preoperative use of NSAIDS like nepefenac,flurbiprofen,ketorolac has been found useful for maintaining intra operative mydriasis and controlling postoperative inflammation by blocking prostaglandin synthesis.This study is taken up in our setup to compare the efficacy of flurbiprofen and Nepafenac OBJECTIVES 1. To measure the horizontal and vertical pupil diameters preoperatively and intraoperatively in Nepafenac group using Castroviejo’s callipers. 2. To measure the horizontal and vertical pupil diameters preoperatively and intraoperatively in Flurbiprofen group using Castroviejo’s callipers. 3. To compare the preoperative and intraoperative horizontal and vertical pupil diameters between Nepafenac group and Flubiprofen group. 4. To assess and compare the postoperative inflammation between the two groups by slit lamp biomicroscopy. XIII Methods: This prospective comparative study was performed on 110 patients, 55 were allocated in each group and were given either of the topical NSAID’s Nepafenac or Flurbiprofen prior to cataract surgery. Pupillary diameter was measured at the beginning and at the end of the surgery and the values were compared between the groups. Postoperative inflammation was also compared between both the groups. Results: The mean pupillary diameter of the two groups were comparable at the beginning of surgery . The difference in horizontal papillary diametres between both the groups was statistically significant (P = 0.04) (p<0.05)at the end of surgery. The difference in vertical pupillary diameters between both the groups was statistically significant (P = 0.000) (p<0.05) at the end of surgery The mean change in the pupillary diameter was more in flurbiprofen group when compared to nepafenac group.There was statistically significant difference among both the groups in maintenance of intraoperative mydriasis .The comparison of postoperative inflammation was also statistically different between both the groups. Postoperative flare on day 1 was compared between both groups (0.35±0.48 in Nepafenac group and 0.59±0.53 in Flurbiprofen group) and it was found to be statistically significant (P = 0.02) (p < 0.05). The postoperative cells on day 1 was compared between both groups (0.35±0.48 in Nepafenac group and 0.79±0.41 in Flurbiprofen group) and there was significant difference found statistically (P = 0.00) (p < 0.05). XIV Conclusions: Pre-operative Nepafenac was found to be better than flurbiprofen in maintaining intraoperative mydriasis and controlling postoperative inflammation