0.1% Nepafenac Vs. 0.09% Bromfenac Eye Drops for Post Laser Peripheral Iridotomy Inflammation - A Randomised Controlled Trial

To assess the safety and efficacy of 0.1% nepafenac versus 0.09% bromfenac eye drops in controlling inflammation following Neodymium Yttrium Aluminium Garnet (Nd:YAG) laser peripheral iridotomy (LPI) DESIGN: Single masked, single centre, randomized controlled trial PARTICIPANTS: One hundred and sixty eyes of Primary Angle Closure Suspects (PACS) and Primary Angle Closure (PAC) patients undergoing bilateral LPI METHODS: Patients were randomized in 1:1 ratio to receive nepafenac 0.1% thrice daily or bromfenac 0.09% eye drops twice daily for 2 weeks following YAG LPI. Assessment was done by masked investigators at 2 weeks after LPI. Glaucoma Symptom Scale (GSS) questionnaire was administered both at baseline and 2 weeks. Subjective comfort scores to the study medications were assessed based on a Likert scale at 2 weeks. In patients with bilateral PACS or PAC, the right eye was analysed and in asymmetrical disease (if one eye had PACS and other eye PAC), the eye with PAC was analysed. The primary outcome (endpoint) was uncontrolled inflammation, defined as symptomatic inflammation within 1 week post-LPI, the presence of anterior chamber cell at 2 weeks, or rebound inflammation after medication discontinuation. The secondary outcome was patient-reported comfort levels to study medications based on GSS and Likert scale. At 2 weeks post-LPI, 7 patients (6 PACS, 1 PAC) in the nepafenac group and 2 PACS patients in bromfenac group achieved the primary endpoint, without a difference between the medication groups (p=0.09). Post-LPI burning, smarting, and stinging was more common in the bromfenac group as compared to the nepafenac group (p=0.01), which also had a higher comfort score on a Likert scale (p=0.004). Need for repeat LPI was comparable (10.0% in the nepafenac group vs. 15.4% in the bromfenac group; p=0.22). Multivariate analysis revealed that a greater number of laser shots was associated with the need for repeat LPI (OR 1.05, 95% CI 1.00-1.10, p=0.04). Topical 0.09% bromfenac is non-inferior to 0.1% nepafenac in controlling inflammation following LPI in PACS and PAC eyes. Nepafenac may be associated with higher patient-reported comfort.