Long-term effects of short-term postoperative bromfenac on macular thickness after phacovitrectomy for idiopathic...

Postoperative macular edema is a recognized complication following vitrectomy for idiopathic epiretinal membrane (ERM), particularly after combined phacovitrectomy. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin-mediated disruption of the blood-retinal barrier, but their long-term anatomical impact after ERM surgery has not been established. We retrospectively reviewed 282 eyes from 279 patients who underwent vitrectomy or phacovitrectomy for idiopathic ERM. Patients were categorized into an Early Use Group (topical bromfenac initiated within 4 weeks postoperatively, n = 91) and a Late/No Use Group (n = 191). The primary outcome was the change in central subfield macular thickness (CSMT) measured by OCT over 6 months. Longitudinal analysis was performed using a linear mixed-effects model (LME) with treatment-by-time interaction as the primary term. LME analysis revealed a significant treatment-by-time interaction for CSMT in the full cohort (F = 4.62, p = 0.003) and in the phacovitrectomy subgroup (F = 6.23, p < 0.001). The Early Use Group showed a significantly greater reduction in CSMT at 6 months (93.9 ± 56.2 μm) compared with the Late/No Use Group (76.6 ± 52.8 μm), with an estimated marginal mean difference of approximately 14-15 μm maintained at all post-baseline time points (p ≤ 0.006). For logMAR BCVA, a significant treatment-by-time interaction was also observed (F = 2.68, p = 0.046): the Early Use Group showed significantly faster visual recovery at 1 month (p = 0.016), but both groups converged to equivalent visual acuity by 6 months (p = 0.305). Early postoperative bromfenac within 4 weeks of phacovitrectomy for ERM significantly reduces macular thickness, and this anatomical benefit is durably maintained for at least 6 months, along with accelerated visual acuity recovery at 1 month. These findings raise the hypothesis that prostaglandin-mediated vascular permeability in the early postoperative period may influence long-term macular remodeling; however, this remains speculative, as direct evidence of permeability changes was not assessed in this study.