The standard first-line treatment for diffuse diabetic macular edema (DDME) is intravitreal injections. Although considered safer and more effective than laser, these drugs may have serious ocular and systemic complications. Recent research of the pharmacological properties of Nepafenac, found that this drug could reach the retina in sufficient concentrations to produce beneficial effects. We evaluated the efficacy of topical nepafenac compared to focal/multifocal laser EPR photostimulation, in patients with DDME.


In a prospective randomized pilot study 23 eyes with DDME were analyzed. The first group, 13 eyes, was treated with one session of barely-visible laser spots and the second one (10 eyes study group) with nepafenac eye drops (three times daily). On the first visit and controls, complete eye examination was performed. Minimum follow-up was 3 months (range 3-10). At each point, best-corrected visual acuity (BCVA) was examined, according to the ETDRS logarithmic scale, as well as the central thickness (CT) and macular volume (MV) by OCT in each study group.


The demographic parameters (age, sex) were homogeneous and comparable between the two groups.

Patients treated with laser had an initial VA (LogMAR) of 0.46 and significant final worsening, 0.53 (p=0.008); CT fell from 390.92 to 288.62 microns (p=0.000) and MV showed a decrease from 11.2 to 10.3 mm3 (p=0.000).

In the group treated with nepafenac, except the VA (LogMAR) that worsened insignificantly from 0.42 to 0.44 (p=0.168), the difference was significant for the CT (from 356.8 to 292.6 microns) and MV (from 11.05 to 10.47 mm3), both with p=0.01.


In our study, nepafenac has been shown to be a clinically effective and safe treatment, able to stabilize the blood-retinal barrier and thereby, reduce macular edema. The obtained visual benefit also was better in patients treated with topical medicament therapy.

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