Effect of Topical Nonsteroidal Anti-inflammatory Drugs on Pupillary Size During Uncomplicated Cataract Surgery.

Purpose: To compare the effectiveness of three different topical nonsteroidal anti-inflammatory drugs (NSAIDs) in inhibiting surgically induced miosis during uncomplicated cataract phacoemulsification.

Methods: Prospective, randomized, double-masked comparative study of patients aged 40 years or older with grades II to III cataracts (Lens Opacities Classification System) and no other comorbidities. Participants were randomized into four groups: 0.1% nepafenac, 0.03% flurbiprofen, 0.4% ketorolac, or lubricant (control group). Medications were applied three times, starting 90 minutes before surgery at 30-minute intervals. Phacoemulsification was performed by the same surgeon using the stop-and-chop technique. Pupillary area and vertical and horizontal pupil diameters were measured at five surgical stages and analyzed with a computerized image system. Multiple comparison tests were performed to analyze intergroup differences. A P value of less than .05 was considered statistically significant.

Results: A total of 88 eyes were included in the study (22 eyes per group). Maximum pupillary area at the end of surgery was observed in the nepafenac group (62.72 ± 9.75 mm) versus the ketorolac, flurbiprofen, and control groups (P = .003, P =.001, and P < .001, respectively). The percentage of pupillary area loss at the end of surgery was 7.50% with nepafenac, 9.84% with flurbiprofen, 10.09% with ketorolac, and 13.83% with control. A trend to larger pupillary area and diameters was found in the nepafenac, flurbiprofen, and ketorolac groups compared with the control group, with better performance in maintaining larger pupil diameters and area in the nepafenac group at all surgical stages.

Conclusions: All NSAIDs were effective in maintaining intraoperative mydriasis during uncomplicated cataract phacoemulsification compared to the control group. [J Refract Surg. 2017;33(4):236-242.].