A prospective randomized clinical trial comparing nepafenac, intravitreal triamcinolone and no adjuvant therapy for epiretinal membrane.

Abstract

PURPOSE\nTo compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA).\n\n\nMETHODS\nDesign: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4\xa0mg/0.1\xa0cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1\xa0month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2\xa0months post-operation.\n\n\nRESULTS\nAlthough all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18\xa0±\xa029.84\xa0μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p\xa0=\xa00.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p\xa0=\xa00.606. There was statistically significant difference in the IOP between the three groups, p\xa0=\xa00.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2\xa0months post-operation (2.72 and 1.58\xa0mmHg, respectively).\n\n\nCONCLUSION\nOur study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.