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

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.

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.

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.

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.