Perspective from Ajay E. Kuriyan, MD, MS
Source:

Donnenfeld ED, et al. J Cataract Refract Surg. 2021;doi:10.1097/j.jcrs.0000000000000414.

Disclosures: Donnenfeld reports he is a consultant to Mati Therapeutics. Please see the study for all other authors’ relevant financial disclosures.
March 08, 2021
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Nepafenac punctal plug significantly reduces postoperative cataract surgery pain

Perspective from Ajay E. Kuriyan, MD, MS
Source:

Donnenfeld ED, et al. J Cataract Refract Surg. 2021;doi:10.1097/j.jcrs.0000000000000414.

Disclosures: Donnenfeld reports he is a consultant to Mati Therapeutics. Please see the study for all other authors’ relevant financial disclosures.
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Patients undergoing cataract surgery treated with a nepafenac punctal plug delivery system experienced significantly less postoperative pain compared with those treated with a placebo punctal plug, according to a study.

“The most important finding of the trial is the nepafenac Evolute patients had a significantly higher percentage of pain-free patients than the placebo group. This included 52% of patients in the nepafenac group who were pain-free at all post-surgical visits vs. 0% in the placebo group,” study co-author and OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, told Healio/OSN.

Researchers evaluated the safety and efficacy of the Evolute nepafenac punctal plug delivery system (Mati Pharmaceuticals) as part of a pilot phase 2 clinical trial. The prospective, multicenter, randomized, double-masked evaluation included 38 eyes that received the nepafenac punctal plug delivery system (N-PPDS) compared with 18 eyes that received a placebo punctal plug delivery system. All eyes underwent routine unilateral cataract surgery, and researchers evaluated postoperative ocular pain and inflammation.

Eric D. Donnenfeld

At 3 days, 69% of patients who received the N-PPDS experienced no ocular pain compared with 38% of patients in the placebo group, a statistically significant difference (P = .038). Overall, 52% of patients in the N-PPDS cohort were pain-free at all postoperative visits compared with 0% in the placebo group (P = .001).

“Postoperative inflammation, as determined by cell and flare scores, also favored the nepafenac Evolute arm. From a clinical perspective, visual acuity was significantly better in the nepafenac arm than the placebo arm,” Donnenfeld said.

The plug retention rate in the overall group was 98.2%, with plug extrusion occurring in one patient in the N-PPDS group before the 1-day postoperative visit. This patient was excluded from the analysis.

The treatment was generally well tolerated with no unexpected side effects reported, Donnenfeld said.

“I feel strongly that the future of medications following cataract surgery is drug delivery that provides low-dose plateaus of therapeutic medications, avoiding the peaks and troughs and the toxicity of preserved topical medications. This trial was the first to investigate a sustained-release use of an NSAID in cataract surgery,” he said.