Comparison of Anti-Inflammatory Effects of Prednisolone versus Nepafenac 0.5 after Phacoemulsification and Intraocular Lens Implantation

Objective: To compare the anti-inflammatory effects and safety profiles of prednisolone acetate 1% and nepafenac 0.5% in patients undergoing phacoemulsification with intraocular lens implantation (IOL). Methods: This retrospective cross-sectional study was conducted at Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan from December 2023 to July 2024. The study included patients underwent uneventful phacoemulsification with IOL implantation. Post-operative outcomes were assessed at a single follow-up conducted at 4 weeks. Primary efficacy endpoint was improvement in best-corrected visual acuity, measured as the reduction in Logarithmic Minimum angle of resolution (logMAR) values from baseline to follow-up. Clinically significant improvement was defined as a reduction of ≥0.2 logMAR units. Secondary outcomes included anterior chamber inflammation, graded using Standardization of Uveitis Nomenclature criteria, and incidence of adverse events. Results: Of total 324 patients, mean age was 64.77 ±9.27 years. Mean logMAR change from baseline to follow-up was 0.28 ±0.11 units in the Prednisolone group and 0.30 ±0.11 units in the Nepafenac group, with statistically significant difference (p-value 0.050). The findings of clinical improvement, showed that 121 (48.8%) patients achieved clinical improvement in the Prednisolone group and 127 (51.2%) in the Nepafenac group. The distribution of inflammation grades (0, 1+, 2+, 3+), was similar between the Prednisolone and Nepafenac groups. A total of 76 (23.4%) adverse events were reported, with 40 (52.6%) occurring in the Prednisolone group and 36 (47.4%) in the Nepafenac group. Conclusion: Both prednisolone acetate and nepafenac are effective and safe in managing post-operative inflammation and improving visual outcomes following phacoemulsification.