Comparative efficacy and safety of combined use of nepafenac 0.3% at night and 0.1% during the day versus single use of nepafenac 0.1% in the management of clinically significant macular edema

Objective: To compare the efficacy and safety of combined use of nepafenac 0.3% at night and nepafenac 0.1% during the day versus single use of nepafenac 0.1% during the day in reducing clinically significant macular edema (CSME). Study Design: A prospective interventional study. Place and Duration of Study: Department of Ophthalmology, MTI-Khyber Teaching Hospital, Peshawar, from January 2024 to June 2024. Methodology: A total of 120 patients diagnosed with CSME were randomly assigned to the "Combined Use" group (n=58) and the "Single Use" group (n=62). Baseline and post-treatment macular thickness were measured via optical coherence tomography, while visual acuity improvement was assessed using Snellen chart values. Efficacy was defined as a ≥50% reduction in macular thickness, and safety was categorized based on the severity of adverse effects. Statistical analysis was performed using independent t-tests and chi-square tests, with a p-value of <0.05 considered significant. Results: The "Combined Use" group demonstrated a significantly greater reduction in post-treatment macular thickness (218.30 ± 30.99 µm) compared to the "Single Use" group (299.44 ± 56.17 µm, p<0.001). Efficacy was achieved in 82.8% of the "Combined Use" group versus 17.7% of the "Single Use" group (p<0.001). Safety profiles were comparable between groups, with most patients categorized as "Safe" (96.6% in "Combined Use" vs. 88.7% in "Single Use", p=0.178). Gender-specific analysis confirmed superior efficacy in the "Combined Use" group for both males and females. Conclusion: The combined use of nepafenac 0.3% at night and nepafenac 0.1% during the day is significantly more effective than single use of nepafenac 0.1% during the day in reducing CSME, with a comparable safety profile.