Choroidal vascularity and thickness modulation with topical nepafenac after phacoemulsification: a comparative study in diabetic and non-diabetic eyes.

PURPOSE: To evaluate the effects of topical 0.3% nepafenac on choroidal thickness (CT), and the choroidal vascularity index (CVI) in diabetic and non-diabetic patients following uncomplicated phacoemulsification.

METHODS

This prospective, randomized study included 104 eyes of 104 patients undergoing uneventful cataract surgery. Participants were randomized to receive topical nepafenac (Group 1, n = 54) or no nepafenac (Group 2, n = 50) and were further stratified by diabetic status (Groups 1A, 1B, 2A, 2B). Optical coherence tomography (OCT) and Enhanced Depth Imaging-OCT assessments of central macular thickness (CMT), CT, and CVI were conducted preoperatively, at postoperative week 1, and week 6. Nepafenac was administered once daily for 6 weeks in Group 1. Intergroup and intragroup changes were analyzed using appropriate statistical tests.

RESULTS

At postoperative week 6, CVI was significantly lower in the nepafenac group compared with controls (p = 0.015), while CMT and CT showed no significant between-group differences. In diabetic participants, CVI increases at week 1 and week 6 were significantly attenuated with nepafenac treatment (p = 0.015 and p = 0.021, respectively). Non-diabetic participants demonstrated no significant nepafenac-related changes in CMT, CT, or CVI (p > 0.05). CT increased during early postoperative follow-up in all groups, whereas no participant developed diabetic macular edema.

CONCLUSIONS

Topical nepafenac significantly reduces postoperative increases in CVI-particularly in diabetic patients-suggesting a protective effect against inflammation-associated choroidal vascular alterations. Nepafenac may help preserve choroidal vascular integrity after cataract surgery, highlighting its value as an adjunctive anti-inflammatory therapy, especially for diabetic individuals at higher inflammatory risk.