Bromfenac versus nepafenac for pain management following transepithelial photorefractive keratectomy

To compare the efficacy of two topical NSAID eye drops, Bromfenac and Nepafenac, in reducing postoperative pain following transepithelial photorefractive keratectomy (t-PRK).

A total of 119 patients undergoing bilateral t-PRK were divided into three groups: Nepafenac (n = 40), Bromfenac (n = 40), or control (n = 39). Nepafenac 0.1% three times daily or Bromfenac 0.07% twice daily, initiated two days preoperatively and continued for three days postoperatively. The control group received systemic paracetamol (500 mg) and ibuprofen (150 mg) tablets as needed.

Overall, both Nepafenac and Bromfenac groups showed significantly lower mean pain levels compared with control group (mean difference = -2.77; 95% CI: -3.63 to - 1.91; p < 0.001, and mean difference = -2.22; 95% CI: -3.01 to -1.43; p < 0.001, respectively). Bromfenac was significantly superior to control only on days 1, 3, and 4. No statistically significant difference in mean pain levels was observed between Bromfenac and Nepafenac groups (mean difference = -0.55; 95% CI: -1.45 to 0.35; p = 0.234). While Nepafenac showed better early symptom control in pain and discomfort (stinging, tearing and light sensitivity), particularly in the first two postoperative days, Bromfenac had a better effect on ocular discomfort in the later postoperative phase on days 4 and 5. Both demonstrated comparable overall tolerability compared to the control.

Both Nepafenac and Bromfenac significantly reduced postoperative pain following t-PRK compared to systemic analgesia. These findings support the use of topical NSAIDs in optimizing post-PRK pain management.