Researchers recently found that topical nepafenac has an additive effect on pupil dilation, which can be particularly useful when evaluating diabetes patients before cataract surgery. Neuropathic complications of diabetes can impair a patient’s pupillary response, providing clinicians a smaller pupil diameter during dilation than unaffected patients. The limited view can hinder the clinician’s ability to effectively assess ocular health prior to surgery. A surgeon adding nepafenac, commonly used to control pain and inflammation, to their presurgical regimen could help achieve sufficient pupil dilation for appropriate management and uncomplicated surgery.

This prospective comparative study evaluated 43 diabetes patients and 39 controls. The team took a baseline pupil diameter measurement and one hour after instilling cyclopentolate 1.0% in both eyes and nepafenac 0.1% to the eye receiving surgery.

The investigators found that baseline pupil diameters of both eyes were similar in both groups. They note that the change in pupil size from baseline to mydriasis was statistically significantly greater in the study eyes (2.69±0.53) than in the fellow eyes (2.54±0.61) in the diabetes group but that there was no statistically significant difference in the control group (2.94±0.63 vs. 2.86±0.58). When the groups were compared, the diameter changes were similar in the study eyes of both groups, while the changes in the fellow eyes were lower in the diabetes group, indicating the enhancing effect of nepafenac on pupil dilation in diabetic patients. Based on their findings, the researchers recommend routine use of topical nepafenac 0.1% for pupil dilation before an exam and pre-cataract surgery to achieve better results.

Kiziltoprak H, Koc M, Yetkin E, et al. Additive effect of topical nepafenac on mydriasis in patients with diabetes mellitus. Eye Contact Lens. September 9, 2019. [Epub ahead of print].