Evaluation of Changes in Macular Thickness following Nepafenac Ophthalmic   Drops in Chronic Diabetes

Muhammad  jahanzaib; Fakhar  Humayun; Saad  Naseer; Usman  Tariq; Fawad Ahmad  Khan; Waqas Rahim  butt

doi:10.51253/pafmj.v75i4.11847

Authors

Muhammad jahanzaib Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Fakhar Humayun Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Saad Naseer Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Usman Tariq Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Fawad Ahmad Khan Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Waqas Rahim butt Department of Ophthalmology, Armed Forces Institute of Ophthalmology/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i4.11847

Keywords:

Diabetes, Macular, Nepafenac, Optic Coherence Tomography, Ophthalmic, Retinopathy

Abstract

Objective: To compare the efficacy of Nepafenac ophthalmic drops in reducing macular inflammation and thickness in chronic diabetic retinopathy using optical coherence tomography (OCT).

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Ophthalmology, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan to Dec 2023.

Methodology: Before initiating treatment, visual acuity was assessed using a standard Snellen chart and documented in the patient records. Baseline foveal thickness was measured in all participants using optical coherence tomography (OCT). All patients then started on 0.1% Nepafenac ophthalmic drops, administered as one drop in each eye twice daily for six months. The primary outcome measures were the change in visual acuity and the change in mean foveal thickness, both evaluated after six months using OCT.

Results: Change in visual acuity (converted from Snellen values to LogMAR) was 0.79±0.21 log units before starting medical treatment, and it was 0.62±0.16 after six months of medical therapy (p<0.001). Change in foveal thickness as assessed by OCT (optic coherence tomography) was 472.14±76.02 microns before the start of medical therapy, and it was 253.69±47.26 microns after six months of treatment (p<0.001).

Conclusion: The study concludes that Nepafenac ophthalmic drops effectively improve macular edema, reduce foveal thickness, and enhance visual acuity in patients with diabetic retinopathy who present with a pre-treatment visual acuity of less than 6/12 on the Snellen Chart.

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References

1. Callanan D, Williams P. Topical nepafenac in the treatment of diabetic macular edema. Clin Ophthalmol 2008; 2(4): 689-692.

https://doi:10.2147/opth.s3965

2. Rahim NE, Flood D, Marcus ME, Theilmann M, Aung TN, Agoudavi K, et al. Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data. Lancet Glob Health 2023; 11(10): e1576-e1586. https://doi:10.1016/S2214-109X(23)00348-0

3. Adnan M, Aasim M. Prevalence of Type 2 Diabetes Mellitus in Adult Population of Pakistan: A Meta-Analysis of Prospective Cross-Sectional Surveys. Ann Glob Health 2020; 86(1): 7.

https://doi:10.5334/aogh.2679

4. Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg 2022; 79: 103901.

https://doi:10.1016/j.amsu.2022.103901

5. Lee SH, Park SY, Choi CS. Insulin Resistance: From Mechanisms to Therapeutic Strategies. Diabetes Metab J 2022; 46(1): 15-37.

https://doi:10.4093/dmj.2021.0280

6. Daryabor G, Atashzar MR, Kabelitz D, Meri S, Kalantar K. The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System. Front Immunol 2020; 11: 1582.

https://doi:10.3389/fimmu.2020.01582

7. Mansour SE, Browning DJ, Wong K, Flynn HW Jr, Bhavsar AR. The Evolving Treatment of Diabetic Retinopathy. Clin Ophthalmol 2020; 14: 653-678.

https://doi:10.2147/OPTH.S236637

8. Chauhan MZ, Rather PA, Samarah SM, Elhusseiny AM, Sallam AB. Current and Novel Therapeutic Approaches for Treatment of Diabetic Macular Edema. Cells 2022; 11(12): 1950.

https://doi:10.3390/cells11121950

9. Everett LA, Paulus YM. Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema. Curr Diab Rep 2021; 21(9): 35.

https://doi:10.1007/s11892-021-01403-6

10. Azzouz L, Durrani A, Zhou Y, Paulus YM. Adjunct Nondamaging Focal Laser Reduces Intravitreal Injection Burden in Diabetic Macular Edema. Photonics 2023; 10(10): 1165.

https://doi:10.3390/photonics10101165

11. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022; 183: 109119.

https://doi:10.1016/j.diabres.2021.109119

12. Sadda SR, Nittala MG, Taweebanjongsin W, Verma A, Velaga SB, Alagorie AR, et al. Quantitative Assessment of the Severity of Diabetic Retinopathy. Am J Ophthalmol 2020; 218: 342-352.

https://doi:10.1016/j.ajo.2020.05.021

13. Li M, Wang Y, Liu Z, Tang X, Mu P, Tan Y, et al. Females with Type 2 Diabetes Mellitus Are Prone to Diabetic Retinopathy: A Twelve-Province Cross-Sectional Study in China. J Diabetes Res 2020; 2020: 5814296. https://doi:10.1155/2020/5814296

14. Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis. Ophthalmology 2021; 128(11): 1580-1591.

https://doi:10.1016/j.ophtha.2021.04.027

15. Brar AS, Sahoo J, Behera UC, Jonas JB, Sivaprasad S, Das T. Prevalence of diabetic retinopathy in urban and rural India: A systematic review and meta-analysis. Indian J Ophthalmol 2022; 70(6): 1945-1955. https://doi:10.4103/ijo.IJO_2206_21

16. Wykoff CC, Khurana RN, Nguyen QD, Kelly SP, Lum F, Hall R, et al. Risk of Blindness Among Patients With Diabetes and Newly Diagnosed Diabetic Retinopathy. Diabetes Care 2021; 44(3): 748-756.

https://doi:10.2337/dc20-0413

17. Thagaard MS, Vergmann AS, Grauslund J. Topical treatment of diabetic retinopathy: a systematic review. Acta Ophthalmol 2022; 100(2): 136-147.

https://doi:10.1111/aos.14912

18. Ahmad A, Haq SU, Hussain J, Rasul J. Comparison of the efficacy of Diclofenac 0.1% and Nepafenac 0.1% on anterior chamber cells in patients undergoing cataract surgery: A prospective clinical practice trial. Pak J Med Sci 2023; 39(5): 1361-1365.

https://doi:10.12669/pjms.39.5.6862

19. Singh R, Alpern L, Jaffe GJ, Lehmann RP, Lim J, Reiser HJ, et al. Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol 2012; 6: 1259-1269.

https://doi:10.2147/OPTH.S31902