Nepafenac versus Ketorolac Eye Drops in Prevention of Intraoperative Miosis during Cataract Surgery

Background: Nepafenac, a novel ophthalmic non-steroidal anti-inflammatory drug (NSAID) with a prodrug structure, was expected to exhibit superior efficacy to traditional NSAIDs regarding individuals' tolerance and the reduction of ocular inflammation following cataract surgery. This research examines and contrasts the effectiveness and safety of Nepafenac and Ketorolac in achieving and sustaining sufficient pupil dilation.Methods: This study is a randomized, double-blinded, controlled, prospective study performed on 105 patients at the Ophthalmology Department, Assiut University Hospitals from March 2018 to April 2019. Patients were randomized into three equal groups according to the cascade of the cataract surgery lists as Groups (1): Nepafenac, (2): Ketorolac, and (3): Artificial tears. This study compared Nepafenac and Ketorolac's efficacy and safety in obtaining and maintaining adequate mydriasis during cataract surgery.Results: There was a significant difference in all groups regarding pupillary Diameter/mm. At the beginning of surgery, there were insignificant differences between groups 1 and 2, while there were significant differences between groups 2 and 3 and between groups 1 and 3. At the end of the surgery, there were insignificant differences between groups 1 and 2 and significant differences between groups 2 and 3 and between groups 1 and 3.Conclusions: Ketorolac is more efficient than Nepafenac in maintaining pupillary dilatation at different stages of cataract surgery, with a relative change of 15.3 % for Nepafenac, 12.9% for Ketorolac and 28.6 % for placebo-measured at the beginning and the end of surgery.