A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery

A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery Ayushi Bansal, Sahleen Ahmad khan, Anzar Ahmad, Summy Bhatnagar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8271622/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Postoperative inflammation and cystoid macular edema (CME) are common challenges following phacoemulsification that may impair visual recovery if not adequately controlled. This prospective, randomized study involving 600 patients compared the efficacy and safety of three anti-inflammatory regimens after uneventful phacoemulsification with IOL implantation: nepafenac 0.3% once daily (Group A), nepafenac 0.1% three times daily (Group B), and loteprednol etabonate 0.5% three times daily (Group C) for 6 weeks. Anterior chamber cells, pain (VAS), conjunctival hyperemia, IOP, and central macular thickness (CMT) on SD-OCT were assessed at weeks 1 and 6. At week 6, Group A demonstrated significantly fewer anterior chamber cells (p = 0.03), lower pain scores (p = 0.04), and the smallest increase in CMT (7.1 ± 3.2 µm versus 13.4 ± 4.7 µm in Group B and 15.6 ± 5.1 µm in Group C; p < 0.001), while the loteprednol group exhibited the highest IOP (17.2 ± 2.5 mmHg; p < 0.001), with no significant intergroup differences in conjunctival hyperemia. Once-daily nepafenac 0.3% therefore proved superior to both nepafenac 0.1% TID and loteprednol 0.5% TID in controlling postoperative inflammation and pain, preventing CME, and avoiding steroid-induced IOP rise, while providing the added benefit of better patient compliance through a simpler dosing schedule. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Cataract remains the leading cause of reversible blindness globally, and with advancements in surgical techniques, phacoemulsification has become the gold standard for cataract extraction.[ 1 ] While modern cataract surgery is minimally invasive and highly successful, postoperative inflammation remains a common sequela that can adversely affect visual recovery and patient satisfaction if not managed effectively.[ 1 ] The inflammatory response following cataract surgery, although expected, involves a cascade of prostaglandin-mediated events, leading to anterior chamber (AC) cell and flare reaction, ocular discomfort, and in some cases, more serious complications such as cystoid macular edema (CME). CME is a sight-threatening condition and a significant cause of suboptimal postoperative visual acuity, especially in high-risk groups [ 2 ]. Traditionally, topical corticosteroids like Loteprednol etabonate have been the cornerstone of postoperative anti-inflammatory therapy due to their potent efficacy. However, steroids are not without limitations. Potential side effects such as elevated intraocular pressure (IOP), delayed wound healing, and increased susceptibility to infection necessitate caution, especially in patients predisposed to steroid response [ 3 ]. Non-steroidal anti-inflammatory drugs (NSAIDs), particularly Nepafenac, have gained popularity as effective alternatives or adjuncts to corticosteroids. Nepafenac is a prodrug that is rapidly converted into amfenac in ocular tissues, allowing for deep ocular penetration and targeted cyclooxygenase inhibition. It has been shown to be effective in reducing postoperative inflammation and in preventing CME, particularly in diabetic patients and those with macular vulnerability [ 4 ]. Two formulations of Nepafenac are commonly used: 0.1%, typically administered three times a day, and 0.3%, which offers the advantage of once-daily dosing. The once-daily 0.3% formulation may improve patient compliance, particularly in elderly populations often burdened by complex medication regimens. However, the comparative efficacy of these formulations, especially against corticosteroids like Loteprednol, is an area still under investigation.[ 5 ] This study was designed to compare the efficacy and safety of 0.3% Nepafenac once daily, 0.1% Nepafenac thrice daily, and 0.5% Loteprednol etabonate thrice daily in controlling postoperative inflammation and preventing CME in patients undergoing uneventful phacoemulsification. We aimed to assess not only clinical outcomes such as anterior chamber cell reaction and macular thickness but also the practical implications of dosing frequency and safety profile in real-world clinical settings. AIM AND OBJECTIVES Aim To compare the efficacy and safety of 0.3% Nepafenac once daily, 0.1% Nepafenac thrice daily, and 0.5% Loteprednol etabonate thrice daily in controlling postoperative inflammation and preventing cystoid macular edema following uneventful phacoemulsification cataract surgery. Objectives To evaluate and compare anterior chamber cell reaction among the three treatment groups at 1 and 6 weeks postoperatively. To assess and compare postoperative ocular pain and conjunctival hyperemia among the three treatment groups. To evaluate the effect of each regimen on central macular thickness (CMT) as a marker for cystoid macular edema (CME) prevention. To monitor and compare changes in intraocular pressure (IOP) associated with each drug. MATERIALS AND METHODS Study Design and Setting This was a prospective, comparative study conducted in the Department of Ophthalmology at Rajshree medical and research institute, Bareilly, from December 2023 to December 2024. The study was approved by the institutional ethics committee and Written informed consent was obtained from all participants. Study Population A total of 600 patients who underwent uneventful phacoemulsification cataract surgery with posterior chamber intraocular lens (IOL) implantation were enrolled and randomly allocated into three equal groups (n = 200 per group). All surgeries were performed by single experienced surgeons under topical anesthesia using standard s clear corneal phacoemulsification techniques. Inclusion Criteria Age ≥ 40 years Visually significant Underwent uneventful phacoemulsification with in-the-bag IOL placement No intraoperative complications Exclusion Criteria History of complicated cataract, glaucoma, uveitis, or retinal disease Diabetes mellitus or any systemic condition affecting macular health Preoperative macular edema or abnormal central macular thickness on OCT Known allergy to study medications Patients requiring perioperative systemic or anti-inflammatory agents Sample Size and Grouping A total of 600 patients were randomized into three equal groups (n = 200 each) using computer-generated random numbers: Group A: 0.3% Nepafenac eye drops once daily (OD). Group B: 0.1% Nepafenac eye drops three times daily (TID). Group C: 0.5% Loteprednol etabonate eye drops three times daily (TID). All medications were started on the day of surgery and continued for six weeks. Study Procedure All surgeries were performed by a single experienced surgeon using a standardized technique to minimize variability. The surgical steps were as follows: A 2.8 mm sutureless clear corneal incision was made under topical anesthesia. A continuous curvilinear capsulorrhexis (CCC) was performed using cystitome. Phacoemulsification was performed using the direct chop technique. A hydrophobic acrylic foldable intraocular lens (IOL) was implanted in the capsular bag. No sutures were applied in any case. Postoperative treatment included: Moxifloxacin 0.5% eye drops four times daily for 2 weeks for infection prophylaxis. Carboxymethylcellulose 1% eye drops four times daily for 6 weeks to maintain ocular surface lubrication and comfort. Assigned anti-inflammatory agent (Nepafenac 0.3%, Nepafenac 0.1%, or Loteprednol 0.5%) as per group allocation. Follow-Up and Outcome Measures All patients were evaluated at three time points: Preoperatively (Baseline) Week 1 Postoperative Week 6 Postoperative At each follow-up visit, the following parameters were assessed: Anterior chamber (AC) cells using slit-lamp examination and graded according to SUN classification. Subjective pain using a Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst pain). Conjunctival hyperemia, graded on a 0–3 scale. Intraocular pressure (IOP) measured using non contact tonometry. Central macular thickness (CMT) evaluated by Spectral-Domain Optical Coherence Tomography (SD-OCT) using the macular map scan protocol. All clinical assessments were performed by a blinded observer to avoid measurement bias. Statistical Analysis Data were recorded and analyzed using SPSS software 28 version. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables as percentages. Intergroup comparisons for continuous variables were done using one-way analysis of variance (ANOVA), while the Chi-square test was used for categorical variables. A p-value < 0.05 was considered statistically significant. RESULTS Demographic and Baseline Characteristics A total of 600 patients were enrolled and equally distributed across the three treatment groups: Group A (0.3% Nepafenac OD), Group B (0.1% Nepafenac TID), and Group C (0.5% Loteprednol TID). The mean age across the groups was comparable (p = 0.78), with the average ranging from 62.9 to 63.4 years. The age-wise distribution did not differ significantly between groups (p > 0.90 for all subcategories). Gender distribution was also similar (p = 0.84), with a slightly higher proportion of males (54.5–57%) in each group. The laterality of the operated eye (right vs. left) was balanced across all arms (p = 0.93). Baseline intraocular pressure (IOP) and central macular thickness (CMT) were comparable (p = 0.89 and 0.92, respectively). All patients presented with an anterior chamber (AC) cell grade of 2 + at baseline as per SUN classification. Table 1 Demographic and Baseline Characteristics Parameter Group A (0.3% Nepafenac) Group B (0.1% Nepafenac) Group C (0.5% Loteprednol) Test Used p-value Mean Age (years) 63.4 ± 7.2 62.9 ± 6.9 63.1 ± 7.0 One-Way ANOVA 0.78 Age Distribution − 40–49 years 28 (14%) 26 (13%) 29 (14.5%) Chi-Square Test 0.92 − 50–59 years 60 (30%) 62 (31%) 59 (29.5%) Chi-Square Test 0.96 − 60–69 years 74 (37%) 73 (36.5%) 75 (37.5%) Chi-Square Test 0.98 - ≥70 years 38 (19%) 39 (19.5%) 37 (18.5%) Chi-Square Test 0.94 Gender Distribution Chi-Square Test 0.84 - Male 112 (56%) 109 (54.5%) 114 (57%) - Female 88 (44%) 91 (45.5%) 86 (43%) Baseline IOP (mmHg) 14.8 ± 2.1 14.6 ± 1.9 14.7 ± 2.2 One-Way ANOVA 0.89 Baseline CMT (µm) 234.2 ± 9.1 233.7 ± 8.8 234.0 ± 9.0 One-Way ANOVA 0.92 AC Cell Grade (SUN criteria) 2 + in all groups 2+ 2+ - - 2. Postoperative Inflammation: AC Cell and Pain Score At Week 1, there was a reduction in AC cell grade in all groups, with Group A showing a slightly greater reduction (1.2 ± 0.5) compared to Group B (1.3 ± 0.6) and Group C (1.4 ± 0.5), though the difference was not statistically significant (p = 0.11). However, by Week 6, a statistically significant difference was observed (p = 0.03), with Group A showing the lowest residual AC cells (0.2 ± 0.1), followed by Groups B and C (both 0.3 ± 0.2). Pain scores also declined in all groups postoperatively. Group A consistently reported the lowest pain scores at both Week 1 and Week 6. The difference became statistically significant at Week 6 (p = 0.04), highlighting superior comfort with once-daily 0.3% Nepafenac. Table 2 AC Cell Grading and Pain Scores Parameter Group A (0.3% Nepafenac) Group B (0.1% Nepafenac) Group C (0.5% Loteprednol) Test Used p-value AC Cells (Week 1) 1.2 ± 0.5 1.3 ± 0.6 1.4 ± 0.5 One-Way ANOVA 0.11 AC Cells (Week 6) 0.2 ± 0.1 0.3 ± 0.2 0.3 ± 0.2 One-Way ANOVA 0.03* Pain Score (Week 1) 2.1 ± 0.6 2.3 ± 0.7 2.4 ± 0.6 One-Way ANOVA 0.08 Pain Score (Week 6) 0.4 ± 0.2 0.5 ± 0.3 0.6 ± 0.3 One-Way ANOVA 0.04* AC Cells (Week 1) Box and whisker plot for AC Cells (Week 1). AC Cells (Week 6) Box and whisker plot for AC Cells (Week 6). Pain Score (Week 1) Box and whisker plot for Pain Score (Week 1). Pain Score (Week 6) Box and whisker plot for Pain Score (Week 6). 3. Conjunctival Hyperemia and Intraocular Pressure Conjunctival hyperemia decreased progressively in all three groups. At Week 6, Groups A and B showed similar reductions (0.3 ± 0.2), while Group C had slightly higher residual hyperemia (0.4 ± 0.3); however, this difference was not statistically significant (p = 0.09). Intraocular pressure at Week 6 was slightly higher in Group C (17.2 ± 2.5 mmHg) compared to Group A (15.0 ± 2.2 mmHg) and Group B (14.9 ± 2.0 mmHg). Although the difference reached statistical significance (p < 0.001), the actual increase in IOP observed with Loteprednol was mild and remained within clinically acceptable limits, suggesting a manageable steroid-related IOP response. Table 3 Conjunctival Hyperemia and IOP Changes Parameter Group A (0.3% Nepafenac) Group B (0.1% Nepafenac) Group C (0.5% Loteprednol) Test Used p-value Hyperemia (Week 1) 1.4 ± 0.5 1.5 ± 0.6 1.6 ± 0.6 One-Way ANOVA 0.18 Hyperemia (Week 6) 0.3 ± 0.2 0.3 ± 0.2 0.4 ± 0.3 One-Way ANOVA 0.09 IOP at Week 6 (mmHg) 15.0 ± 2.2 14.9 ± 2.0 17.2 ± 2.5 One-Way ANOVA < 0.001* Hyperemia (Week 1) Box and whisker plot for Hyperemia (Week 1). Hyperemia (Week 6) Box and whisker plot for Hyperemia (Week 6). 4. Central Macular Thickness (CMT) All groups showed some increase in CMT at Week 6; however, the increase was most modest in Group A (7.1 ± 3.2 µm) compared to Group B (13.4 ± 4.7 µm) and Group C (15.6 ± 5.1 µm). The difference in mean increase was statistically significant (p < 0.001). This finding implies superior prophylaxis against cystoid macular edema (CME) with once-daily 0.3% Nepafenac. Table 4 Central Macular Thickness (CMT) Changes Parameter Group A(0.3% Nepafenac) Group B(0.1% Nepafenac) Group C(0.5% Loteprednol) Test Used p-value Baseline CMT (µm) 234.2 ± 9.1 233.7 ± 8.8 234.0 ± 9.0 One-Way ANOVA 0.92 CMT at Week 6 (µm) 241.3 ± 10.5 247.1 ± 11.3 249.6 ± 12.0 One-Way ANOVA < 0.001* Mean Increase in CMT 7.1 ± 3.2 13.4 ± 4.7 15.6 ± 5.1 One-Way ANOVA < 0.001* DISCUSSION This study aimed to evaluate and compare the efficacy of 0.3% nepafenac (once daily), 0.1% nepafenac (three times daily), and 0.5% loteprednol (three times daily) in controlling postoperative inflammation and preventing complications following uneventful phacoemulsification. The results revealed significant differences between these agents, particularly in terms of anterior chamber (AC) cell resolution, pain control, IOP changes, and central macular thickness (CMT) at the 6-week follow-up. Inflammation Control and AC Cells At Week 6, 0.3% nepafenac demonstrated superior efficacy in reducing inflammation, as evidenced by significantly lower AC cell counts compared to both 0.1% nepafenac and 0.5% loteprednol (p = 0.03). This aligns with the findings of Nanda et al. (2022)[ 6 ], who reported a lower rise in CMT and fewer AC cells in the 0.3% nepafenac group compared to 0.1% nepafenac after phacoemulsification (p < 0.001). Our study confirmed that the once-daily dose of 0.3% nepafenac was effective in controlling inflammation, a result also seen in the study by Modi et al. (2013)[ 7 ], where 0.3% nepafenac proved more effective than 0.1% nepafenac in preventing inflammation and controlling pain after cataract surgery. Pain Control Pain scores were significantly lower in 0.3% nepafenac compared to the other two groups at Week 6 (p = 0.04). These findings mirror the study by Bardoloi et al. (2021)[ 5 ], where the 0.3% nepafenac group experienced less postoperative pain than the 0.1% nepafenac group. Although the pain scores were statistically similar across all groups at Week 1, the progressive reduction in pain was more pronounced in the 0.3% nepafenac group by Week 6, suggesting that a once-daily dosage might offer superior, sustained pain relief. Conjunctival Hyperemia and IOP In terms of conjunctival hyperemia, there were no statistically significant differences between the groups (p = 0.09). However, in a study by Singhal et al. (2022)[ 8 ], the 0.3% nepafenac group exhibited less conjunctival hyperemia compared to other NSAIDs, corroborating our findings that nepafenac, particularly at higher concentrations, tends to produce fewer signs of ocular irritation. The IOP at Week 6 was significantly higher in the loteprednol group (p < 0.001), which is consistent with previous studies indicating that corticosteroids like loteprednol may have a more significant impact on IOP compared to NSAIDs (Singhal et al., 2022)[ 8 ]. Elevated IOP is a well-known side effect of topical corticosteroids, and our results further substantiate this. Central Macular Thickness (CMT) The increase in CMT at Week 6 was significantly greater in the 0.1% nepafenac and 0.5% loteprednol groups compared to the 0.3% nepafenac group, with 0.3% nepafenac showing the least increase in CMT (p < 0.001). This finding is consistent with Nanda et al. (2022)[ 6 ], where 0.3% nepafenac resulted in less macular edema compared to corticosteroids, emphasizing its efficacy in preventing cystoid macular edema (CME). Loteprednol, a corticosteroid, demonstrated a higher rise in CMT, reflecting its potential in promoting macular edema, which is a known risk factor for visual compromise post-surgery (Singhal et al., 2022)[ 8 ]. Comparison to Previous Studies In comparison to previous studies, our findings underscore the advantage of 0.3% nepafenac as a once-daily agent, which proved effective in controlling inflammation and reducing pain with a favorable safety profile. Modi et al. (2013)[ 7 ] demonstrated that 0.3% nepafenac provided a noninferior effect to 0.1% nepafenac and was better at reducing inflammation and pain, a result reflected in our study, which also showed superior pain control and inflammation resolution in the 0.3% nepafenac group. Similarly, Nanda et al. (2022)[ 6 ] also found that 0.3% nepafenac resulted in less macular edema compared to corticosteroids, aligning with our finding of minimal increase in CMT. Contrary to previous findings, loteprednol in our study showed higher IOP levels and greater macular thickening compared to both 0.3% nepafenac and 0.1% nepafenac, which is in line with Singhal et al. (2022)[ 8 ], who also noted that topical corticosteroids had a greater propensity to elevate IOP and cause macular edema compared to NSAIDs. Bardoloi et al. (2021) highlighted that 0.1% nepafenac was less effective in controlling inflammation and pain compared to 0.3% nepafenac, which supports our findings that a higher concentration of nepafenac provides more sustained relief and superior outcomes. Limitations and Future Directions One limitation of this study is the lack of long-term follow-up beyond 6 weeks, as macular edema and IOP changes may continue to evolve over time. Future studies with extended follow-up periods could further elucidate the long-term safety and efficacy of 0.3% nepafenac in comparison to corticosteroids. Additionally, studies involving a larger sample size and multicentric data could help generalize the findings. Conclusion In conclusion, 0.3% nepafenac (once daily) is more effective than both 0.1% nepafenac (three times daily) and 0.5% loteprednol (three times daily) in managing postoperative inflammation, controlling pain, and reducing the incidence of cystoid macular edema (CME) following uneventful phacoemulsification. The once-daily dosing of 0.3% nepafenac not only ensures better patient compliance due to single-use convenience, but also offers significant advantages over loteprednol in terms of macular thickness, pain relief, and intraocular pressure (IOP) control. These findings make 0.3% nepafenac a preferable option for postoperative inflammation management in cataract surgery. Declarations Conflicts of interest/Competing interests The authors declare that they have no conflicts of interest or competing interests. Ethics approval The study was approved by the Rajshree medical research institute and hospital Bareilley (Approval No. RMRIH/IEC/2024/145 dated 12/04/2024). Consent to participate Written informed consent was obtained from all individual participants included in the study (or from their legally authorized representatives in case of inability to provide consent). Written consent for publication Patients signed informed consent regarding publishing their data and clinical details. Identifying information has been removed to maintain anonymity. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution AB and SAK: Conceptualization, supervision, critical revision of the manuscript, correspondenceAB: Data curation, investigation, original draft writingSB, AA and VS: Methodology, formal analysis, writing – review & editing.All authors read and approved the final manuscript. Data Availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. References Gurnani B, Kaur K. Phacoemulsification. [Updated 2023 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK576419/ Kim SJ, Equi R, Bressler NM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007;114(5):881–9. doi: 10.1016/j.ophtha.2006.08.053 . Epub 2007 Feb 1. PMID: 17275910. Bartlett JD, Jaanus SD. Clinical Ocular Pharmacology. 5th ed. Elsevier; 2007. Chapter 10: Corticosteroids and Anti-inflammatory Agents. Silverstein SM. Bromfenac Ophthalmic Solution 0.07% Versus Nepafenac Ophthalmic Suspension 0.3% for Post-Cataract Surgery Inflammation: A Pilot Study of Identical Dosing Regimens with Pre-Surgical "Pulse" Dose. Ophthalmol Ther. 2019;8(4):577–587. doi: 10.1007/s40123-019-00215-y . Epub 2019 Sep 24. PMID: 31552543; PMCID: PMC6858409. Bardoloi N, Sarkar S, Burgute PS, Deb AK, Dholkawala R, Aggarwal P, Gokhale T. Comparison of once daily dose of 0.3% nepafenac alone and three times dose of 0.1% nepafenac alone in pain and inflammation control after phacoemulsification. Indian J Ophthalmol. 2022;70(3):807–812. doi: 10.4103/ijo.IJO_2401_21 . PMID: 35225519; PMCID: PMC9114608. Nanda AK, Kanungo S, Swain A. A comparison of efficacy of Nepafenac 0.1% with Nepafenac 0.3% drops for the management of post-operative inflammation and CME in uneventful phacoemulsification. Int J Res Rev. 2022;9(3):228–233. doi: 10.52403/ijrr.20220327 . Modi SS, Lehmann RP, Walters TR, Fong R, Christie WC, Roel L, Nethery D, Sager D, Tsorbatzoglou A, Philipson B, Traverso CE, Reiser H. Once-daily nepafenac ophthalmic suspension 0.3% to prevent and treat ocular inflammation and pain after cataract surgery: phase 3 study. J Cataract Refract Surg. 2014;40(2):203–11. doi: 10.1016/j.jcrs.2013.07.042. Epub 2013 Dec 15. PMID: 24345529. Singhal D, Nanda A, Kanungo S, Sahoo K, Mohapatra S. A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification. Indian J Ophthalmol. 2022;70(2):425–433. doi: 10.4103/ijo.IJO_1612_21 . PMID: 35086209; PMCID: PMC9023946. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":55418,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/428e24798e47921ccd7b17a4.png"},{"id":99217040,"identity":"0f7dd1c1-7e89-44c0-bbe5-d7582c9e54a8","added_by":"auto","created_at":"2025-12-30 09:10:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69688,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/9ded5109315cf007c215100f.png"},{"id":99217051,"identity":"8f4891d5-b660-4da6-be7e-f89f3231f185","added_by":"auto","created_at":"2025-12-30 09:10:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54630,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/4531a080e219984615020860.png"},{"id":99217057,"identity":"2953e5c6-1dad-4f0e-b271-d44cb27dd623","added_by":"auto","created_at":"2025-12-30 09:10:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":67904,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/629742bd09edc58139a49760.png"},{"id":99217041,"identity":"6532e4b0-9bec-42db-b123-d699cb3358f6","added_by":"auto","created_at":"2025-12-30 09:10:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":60563,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/712202c4b6e7ff714bf7f3ba.png"},{"id":99217059,"identity":"497df43e-b5ab-4686-9490-0384b8bf1fe3","added_by":"auto","created_at":"2025-12-30 09:10:04","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":70791,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8271622/v1/bb324dfe684256aa59c630f3.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCataract remains the leading cause of reversible blindness globally, and with advancements in surgical techniques, phacoemulsification has become the gold standard for cataract extraction.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] While modern cataract surgery is minimally invasive and highly successful, postoperative inflammation remains a common sequela that can adversely affect visual recovery and patient satisfaction if not managed effectively.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe inflammatory response following cataract surgery, although expected, involves a cascade of prostaglandin-mediated events, leading to anterior chamber (AC) cell and flare reaction, ocular discomfort, and in some cases, more serious complications such as cystoid macular edema (CME). CME is a sight-threatening condition and a significant cause of suboptimal postoperative visual acuity, especially in high-risk groups [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditionally, topical corticosteroids like Loteprednol etabonate have been the cornerstone of postoperative anti-inflammatory therapy due to their potent efficacy. However, steroids are not without limitations. Potential side effects such as elevated intraocular pressure (IOP), delayed wound healing, and increased susceptibility to infection necessitate caution, especially in patients predisposed to steroid response [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNon-steroidal anti-inflammatory drugs (NSAIDs), particularly Nepafenac, have gained popularity as effective alternatives or adjuncts to corticosteroids. Nepafenac is a prodrug that is rapidly converted into amfenac in ocular tissues, allowing for deep ocular penetration and targeted cyclooxygenase inhibition. It has been shown to be effective in reducing postoperative inflammation and in preventing CME, particularly in diabetic patients and those with macular vulnerability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo formulations of Nepafenac are commonly used: 0.1%, typically administered three times a day, and 0.3%, which offers the advantage of once-daily dosing. The once-daily 0.3% formulation may improve patient compliance, particularly in elderly populations often burdened by complex medication regimens. However, the comparative efficacy of these formulations, especially against corticosteroids like Loteprednol, is an area still under investigation.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis study was designed to compare the efficacy and safety of 0.3% Nepafenac once daily, 0.1% Nepafenac thrice daily, and 0.5% Loteprednol etabonate thrice daily in controlling postoperative inflammation and preventing CME in patients undergoing uneventful phacoemulsification. We aimed to assess not only clinical outcomes such as anterior chamber cell reaction and macular thickness but also the practical implications of dosing frequency and safety profile in real-world clinical settings.\u003c/p\u003e"},{"header":"AIM AND OBJECTIVES","content":"\u003cp\u003eAim\u003c/p\u003e \u003cp\u003eTo compare the efficacy and safety of 0.3% Nepafenac once daily, 0.1% Nepafenac thrice daily, and 0.5% Loteprednol etabonate thrice daily in controlling postoperative inflammation and preventing cystoid macular edema following uneventful phacoemulsification cataract surgery.\u003c/p\u003e \u003cp\u003eObjectives\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo evaluate and compare anterior chamber cell reaction among the three treatment groups at 1 and 6 weeks postoperatively.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess and compare postoperative ocular pain and conjunctival hyperemia among the three treatment groups.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo evaluate the effect of each regimen on central macular thickness (CMT) as a marker for cystoid macular edema (CME) prevention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo monitor and compare changes in intraocular pressure (IOP) associated with each drug.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis was a prospective, comparative study conducted in the Department of Ophthalmology at Rajshree medical and research institute, Bareilly, from December 2023 to December 2024. The study was approved by the institutional ethics committee and Written informed consent was obtained from all participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eA total of 600 patients who underwent uneventful phacoemulsification cataract surgery with posterior chamber intraocular lens (IOL) implantation were enrolled and randomly allocated into three equal groups (n\u0026thinsp;=\u0026thinsp;200 per group). All surgeries were performed by single experienced surgeons under topical anesthesia using standard s clear corneal phacoemulsification techniques.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;40 years\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eVisually significant\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnderwent uneventful phacoemulsification with in-the-bag IOL placement\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo intraoperative complications\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion Criteria\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHistory of complicated cataract, glaucoma, uveitis, or retinal disease\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDiabetes mellitus or any systemic condition affecting macular health\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreoperative macular edema or abnormal central macular thickness on OCT\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnown allergy to study medications\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients requiring perioperative systemic or anti-inflammatory agents\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eSample Size and Grouping\u003c/p\u003e \u003cp\u003eA total of 600 patients were randomized into three equal groups (n\u0026thinsp;=\u0026thinsp;200 each) using computer-generated random numbers:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup A: 0.3% Nepafenac eye drops once daily (OD).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup B: 0.1% Nepafenac eye drops three times daily (TID).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGroup C: 0.5% Loteprednol etabonate eye drops three times daily (TID).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAll medications were started on the day of surgery and continued for six weeks.\u003c/p\u003e \u003cp\u003eStudy Procedure\u003c/p\u003e \u003cp\u003eAll surgeries were performed by a single experienced surgeon using a standardized technique to minimize variability. The surgical steps were as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA 2.8 mm sutureless clear corneal incision was made under topical anesthesia.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA continuous curvilinear capsulorrhexis (CCC) was performed using cystitome.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePhacoemulsification was performed using the direct chop technique.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA hydrophobic acrylic foldable intraocular lens (IOL) was implanted in the capsular bag.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo sutures were applied in any case.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003ePostoperative treatment included:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMoxifloxacin 0.5% eye drops four times daily for 2 weeks for infection prophylaxis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCarboxymethylcellulose 1% eye drops four times daily for 6 weeks to maintain ocular surface lubrication and comfort.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAssigned anti-inflammatory agent (Nepafenac 0.3%, Nepafenac 0.1%, or Loteprednol 0.5%) as per group allocation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eFollow-Up and Outcome Measures\u003c/p\u003e \u003cp\u003eAll patients were evaluated at three time points:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreoperatively (Baseline)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWeek 1 Postoperative\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWeek 6 Postoperative\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAt each follow-up visit, the following parameters were assessed:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAnterior chamber (AC) cells using slit-lamp examination and graded according to SUN classification.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSubjective pain using a Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst pain).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConjunctival hyperemia, graded on a 0\u0026ndash;3 scale.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIntraocular pressure (IOP) measured using non contact tonometry.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCentral macular thickness (CMT) evaluated by Spectral-Domain Optical Coherence Tomography (SD-OCT) using the macular map scan protocol.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAll clinical assessments were performed by a blinded observer to avoid measurement bias.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were recorded and analyzed using SPSS software 28 version. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and categorical variables as percentages. Intergroup comparisons for continuous variables were done using one-way analysis of variance (ANOVA), while the Chi-square test was used for categorical variables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDemographic and Baseline Characteristics\u003c/p\u003e \u003cp\u003eA total of 600 patients were enrolled and equally distributed across the three treatment groups: Group A (0.3% Nepafenac OD), Group B (0.1% Nepafenac TID), and Group C (0.5% Loteprednol TID). The mean age across the groups was comparable (p\u0026thinsp;=\u0026thinsp;0.78), with the average ranging from 62.9 to 63.4 years. The age-wise distribution did not differ significantly between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.90 for all subcategories). Gender distribution was also similar (p\u0026thinsp;=\u0026thinsp;0.84), with a slightly higher proportion of males (54.5\u0026ndash;57%) in each group. The laterality of the operated eye (right vs. left) was balanced across all arms (p\u0026thinsp;=\u0026thinsp;0.93). Baseline intraocular pressure (IOP) and central macular thickness (CMT) were comparable (p\u0026thinsp;=\u0026thinsp;0.89 and 0.92, respectively). All patients presented with an anterior chamber (AC) cell grade of 2\u0026thinsp;+\u0026thinsp;at baseline as per SUN classification.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Baseline Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.3% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.1% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.5% Loteprednol)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Distribution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;40\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;50\u0026ndash;59 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;60\u0026ndash;69 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- \u0026ge;70 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender Distribution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eChi-Square Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline IOP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline CMT (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e234.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e234.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC Cell Grade (SUN criteria)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026thinsp;+\u0026thinsp;in all groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e2. Postoperative Inflammation: AC Cell and Pain Score\u003c/p\u003e \u003cp\u003eAt Week 1, there was a reduction in AC cell grade in all groups, with Group A showing a slightly greater reduction (1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5) compared to Group B (1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6) and Group C (1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5), though the difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.11). However, by Week 6, a statistically significant difference was observed (p\u0026thinsp;=\u0026thinsp;0.03), with Group A showing the lowest residual AC cells (0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1), followed by Groups B and C (both 0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2).\u003c/p\u003e \u003cp\u003ePain scores also declined in all groups postoperatively. Group A consistently reported the lowest pain scores at both Week 1 and Week 6. The difference became statistically significant at Week 6 (p\u0026thinsp;=\u0026thinsp;0.04), highlighting superior comfort with once-daily 0.3% Nepafenac.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAC Cell Grading and Pain Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.3% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.1% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.5% Loteprednol)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC Cells (Week 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAC Cells (Week 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.03*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Score (Week 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain Score (Week 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAC Cells (Week 1)\u003c/p\u003e \u003cp\u003eBox and whisker plot for AC Cells (Week 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAC Cells (Week 6)\u003c/p\u003e \u003cp\u003eBox and whisker plot for AC Cells (Week 6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePain Score (Week 1)\u003c/p\u003e \u003cp\u003eBox and whisker plot for Pain Score (Week 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePain Score (Week 6)\u003c/p\u003e \u003cp\u003eBox and whisker plot for Pain Score (Week 6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e3. Conjunctival Hyperemia and Intraocular Pressure\u003c/p\u003e \u003cp\u003eConjunctival hyperemia decreased progressively in all three groups. At Week 6, Groups A and B showed similar reductions (0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2), while Group C had slightly higher residual hyperemia (0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3); however, this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.09). Intraocular pressure at Week 6 was slightly higher in Group C (17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 mmHg) compared to Group A (15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 mmHg) and Group B (14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 mmHg). Although the difference reached statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the actual increase in IOP observed with Loteprednol was mild and remained within clinically acceptable limits, suggesting a manageable steroid-related IOP response.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConjunctival Hyperemia and IOP Changes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.3% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.1% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C\u0026thinsp;\u0026lt;\u0026thinsp;br\u0026gt;(0.5% Loteprednol)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperemia (Week 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperemia (Week 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIOP at Week 6 (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHyperemia (Week 1)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBox and whisker plot for Hyperemia (Week 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHyperemia (Week 6)\u003c/p\u003e \u003cp\u003eBox and whisker plot for Hyperemia (Week 6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e4. Central Macular Thickness (CMT)\u003c/p\u003e \u003cp\u003eAll groups showed some increase in CMT at Week 6; however, the increase was most modest in Group A (7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 \u0026micro;m) compared to Group B (13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 \u0026micro;m) and Group C (15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 \u0026micro;m). The difference in mean increase was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding implies superior prophylaxis against cystoid macular edema (CME) with once-daily 0.3% Nepafenac.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCentral Macular Thickness (CMT) Changes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A(0.3% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B(0.1% Nepafenac)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C(0.5% Loteprednol)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Used\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline CMT (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e234.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e233.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e234.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMT at Week 6 (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e241.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e247.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e249.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Increase in CMT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOne-Way ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to evaluate and compare the efficacy of 0.3% nepafenac (once daily), 0.1% nepafenac (three times daily), and 0.5% loteprednol (three times daily) in controlling postoperative inflammation and preventing complications following uneventful phacoemulsification. The results revealed significant differences between these agents, particularly in terms of anterior chamber (AC) cell resolution, pain control, IOP changes, and central macular thickness (CMT) at the 6-week follow-up.\u003c/p\u003e\n\u003ch3\u003eInflammation Control and AC Cells\u003c/h3\u003e\n\u003cp\u003eAt Week 6, 0.3% nepafenac demonstrated superior efficacy in reducing inflammation, as evidenced by significantly lower AC cell counts compared to both 0.1% nepafenac and 0.5% loteprednol (p\u0026thinsp;=\u0026thinsp;0.03). This aligns with the findings of Nanda et al. (2022)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], who reported a lower rise in CMT and fewer AC cells in the 0.3% nepafenac group compared to 0.1% nepafenac after phacoemulsification (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Our study confirmed that the once-daily dose of 0.3% nepafenac was effective in controlling inflammation, a result also seen in the study by Modi et al. (2013)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], where 0.3% nepafenac proved more effective than 0.1% nepafenac in preventing inflammation and controlling pain after cataract surgery.\u003c/p\u003e\n\u003ch3\u003ePain Control\u003c/h3\u003e\n\u003cp\u003ePain scores were significantly lower in 0.3% nepafenac compared to the other two groups at Week 6 (p\u0026thinsp;=\u0026thinsp;0.04). These findings mirror the study by Bardoloi et al. (2021)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], where the 0.3% nepafenac group experienced less postoperative pain than the 0.1% nepafenac group. Although the pain scores were statistically similar across all groups at Week 1, the progressive reduction in pain was more pronounced in the 0.3% nepafenac group by Week 6, suggesting that a once-daily dosage might offer superior, sustained pain relief.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConjunctival Hyperemia and IOP\u003c/h2\u003e \u003cp\u003eIn terms of conjunctival hyperemia, there were no statistically significant differences between the groups (p\u0026thinsp;=\u0026thinsp;0.09). However, in a study by Singhal et al. (2022)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the 0.3% nepafenac group exhibited less conjunctival hyperemia compared to other NSAIDs, corroborating our findings that nepafenac, particularly at higher concentrations, tends to produce fewer signs of ocular irritation. The IOP at Week 6 was significantly higher in the loteprednol group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which is consistent with previous studies indicating that corticosteroids like loteprednol may have a more significant impact on IOP compared to NSAIDs (Singhal et al., 2022)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Elevated IOP is a well-known side effect of topical corticosteroids, and our results further substantiate this.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCentral Macular Thickness (CMT)\u003c/h2\u003e \u003cp\u003eThe increase in CMT at Week 6 was significantly greater in the 0.1% nepafenac and 0.5% loteprednol groups compared to the 0.3% nepafenac group, with 0.3% nepafenac showing the least increase in CMT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding is consistent with Nanda et al. (2022)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], where 0.3% nepafenac resulted in less macular edema compared to corticosteroids, emphasizing its efficacy in preventing cystoid macular edema (CME). Loteprednol, a corticosteroid, demonstrated a higher rise in CMT, reflecting its potential in promoting macular edema, which is a known risk factor for visual compromise post-surgery (Singhal et al., 2022)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eComparison to Previous Studies\u003c/h2\u003e \u003cp\u003eIn comparison to previous studies, our findings underscore the advantage of 0.3% nepafenac as a once-daily agent, which proved effective in controlling inflammation and reducing pain with a favorable safety profile. Modi et al. (2013)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] demonstrated that 0.3% nepafenac provided a noninferior effect to 0.1% nepafenac and was better at reducing inflammation and pain, a result reflected in our study, which also showed superior pain control and inflammation resolution in the 0.3% nepafenac group. Similarly, Nanda et al. (2022)[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] also found that 0.3% nepafenac resulted in less macular edema compared to corticosteroids, aligning with our finding of minimal increase in CMT.\u003c/p\u003e \u003cp\u003eContrary to previous findings, loteprednol in our study showed higher IOP levels and greater macular thickening compared to both 0.3% nepafenac and 0.1% nepafenac, which is in line with Singhal et al. (2022)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], who also noted that topical corticosteroids had a greater propensity to elevate IOP and cause macular edema compared to NSAIDs. Bardoloi et al. (2021) highlighted that 0.1% nepafenac was less effective in controlling inflammation and pain compared to 0.3% nepafenac, which supports our findings that a higher concentration of nepafenac provides more sustained relief and superior outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e \u003cp\u003eOne limitation of this study is the lack of long-term follow-up beyond 6 weeks, as macular edema and IOP changes may continue to evolve over time. Future studies with extended follow-up periods could further elucidate the long-term safety and efficacy of 0.3% nepafenac in comparison to corticosteroids. Additionally, studies involving a larger sample size and multicentric data could help generalize the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, 0.3% nepafenac (once daily) is more effective than both 0.1% nepafenac (three times daily) and 0.5% loteprednol (three times daily) in managing postoperative inflammation, controlling pain, and reducing the incidence of cystoid macular edema (CME) following uneventful phacoemulsification. The once-daily dosing of 0.3% nepafenac not only ensures better patient compliance due to single-use convenience, but also offers significant advantages over loteprednol in terms of macular thickness, pain relief, and intraocular pressure (IOP) control. These findings make 0.3% nepafenac a preferable option for postoperative inflammation management in cataract surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of interest/Competing interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest or competing interests.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003eThe study was approved by the Rajshree medical research institute and hospital Bareilley (Approval No. RMRIH/IEC/2024/145 dated 12/04/2024).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from all individual participants included in the study (or from their legally authorized representatives in case of inability to provide consent).\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eWritten consent for publication\u003c/h2\u003e \u003cp\u003ePatients signed informed consent regarding publishing their data and clinical details. Identifying information has been removed to maintain anonymity.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAB and SAK: Conceptualization, supervision, critical revision of the manuscript, correspondenceAB: Data curation, investigation, original draft writingSB, AA and VS: Methodology, formal analysis, writing \u0026ndash; review \u0026amp; editing.All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGurnani B, Kaur K. Phacoemulsification. [Updated 2023 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK576419/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK576419/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SJ, Equi R, Bressler NM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007;114(5):881\u0026ndash;9. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ophtha.2006.08.053\u003c/span\u003e\u003cspan address=\"10.1016/j.ophtha.2006.08.053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2007 Feb 1. PMID: 17275910.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBartlett JD, Jaanus SD. Clinical Ocular Pharmacology. 5th ed. Elsevier; 2007. Chapter 10: Corticosteroids and Anti-inflammatory Agents.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilverstein SM. Bromfenac Ophthalmic Solution 0.07% Versus Nepafenac Ophthalmic Suspension 0.3% for Post-Cataract Surgery Inflammation: A Pilot Study of Identical Dosing Regimens with Pre-Surgical \"Pulse\" Dose. Ophthalmol Ther. 2019;8(4):577\u0026ndash;587. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40123-019-00215-y\u003c/span\u003e\u003cspan address=\"10.1007/s40123-019-00215-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2019 Sep 24. PMID: 31552543; PMCID: PMC6858409.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBardoloi N, Sarkar S, Burgute PS, Deb AK, Dholkawala R, Aggarwal P, Gokhale T. Comparison of once daily dose of 0.3% nepafenac alone and three times dose of 0.1% nepafenac alone in pain and inflammation control after phacoemulsification. Indian J Ophthalmol. 2022;70(3):807\u0026ndash;812. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_2401_21\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_2401_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35225519; PMCID: PMC9114608.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNanda AK, Kanungo S, Swain A. A comparison of efficacy of Nepafenac 0.1% with Nepafenac 0.3% drops for the management of post-operative inflammation and CME in uneventful phacoemulsification. \u003cem\u003eInt J Res Rev.\u003c/em\u003e 2022;9(3):228\u0026ndash;233. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.52403/ijrr.20220327\u003c/span\u003e\u003cspan address=\"10.52403/ijrr.20220327\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eModi SS, Lehmann RP, Walters TR, Fong R, Christie WC, Roel L, Nethery D, Sager D, Tsorbatzoglou A, Philipson B, Traverso CE, Reiser H. Once-daily nepafenac ophthalmic suspension 0.3% to prevent and treat ocular inflammation and pain after cataract surgery: phase 3 study. J Cataract Refract Surg. 2014;40(2):203\u0026ndash;11. doi: 10.1016/j.jcrs.2013.07.042. Epub 2013 Dec 15. PMID: 24345529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinghal D, Nanda A, Kanungo S, Sahoo K, Mohapatra S. A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification. Indian J Ophthalmol. 2022;70(2):425\u0026ndash;433. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_1612_21\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_1612_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 35086209; PMCID: PMC9023946.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8271622/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8271622/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePostoperative inflammation and cystoid macular edema (CME) are common challenges following phacoemulsification that may impair visual recovery if not adequately controlled. This prospective, randomized study involving 600 patients compared the efficacy and safety of three anti-inflammatory regimens after uneventful phacoemulsification with IOL implantation: nepafenac 0.3% once daily (Group A), nepafenac 0.1% three times daily (Group B), and loteprednol etabonate 0.5% three times daily (Group C) for 6 weeks. Anterior chamber cells, pain (VAS), conjunctival hyperemia, IOP, and central macular thickness (CMT) on SD-OCT were assessed at weeks 1 and 6. At week 6, Group A demonstrated significantly fewer anterior chamber cells (p\u0026thinsp;=\u0026thinsp;0.03), lower pain scores (p\u0026thinsp;=\u0026thinsp;0.04), and the smallest increase in CMT (7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 \u0026micro;m versus 13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 \u0026micro;m in Group B and 15.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 \u0026micro;m in Group C; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the loteprednol group exhibited the highest IOP (17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 mmHg; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with no significant intergroup differences in conjunctival hyperemia. Once-daily nepafenac 0.3% therefore proved superior to both nepafenac 0.1% TID and loteprednol 0.5% TID in controlling postoperative inflammation and pain, preventing CME, and avoiding steroid-induced IOP rise, while providing the added benefit of better patient compliance through a simpler dosing schedule.\u003c/p\u003e","manuscriptTitle":"A comparative analysis of 0.3% Nepafenac alone vs 0.1% Nepafenac vs 0.5% Loteprednol to control post operative inflammation in patients who underwent uneventful phacoemulsification cataract surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:08:23","doi":"10.21203/rs.3.rs-8271622/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-24T10:51:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-06T03:52:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262690858162437286482314602458773460223","date":"2025-12-28T20:56:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123681089617808641483549734091531200760","date":"2025-12-26T07:17:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-23T17:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56522888709383926187835672298198179305","date":"2025-12-23T11:39:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-23T11:01:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-04T07:20:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-04T07:20:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Ophthalmology","date":"2025-12-03T14:50:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cf3e0e63-e859-4c91-b6e4-0c4c75e01e09","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-24T10:55:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:08:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8271622","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8271622","identity":"rs-8271622","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}