Nevanac (Nepafenac) is NOT indicated for moderate NPDR
Nevanac (nepafenac) is a topical NSAID used for post-cataract surgery inflammation and macular edema prevention—it has no role in treating moderate non-proliferative diabetic retinopathy itself. 1
Understanding the Medication vs. the Condition
What Nevanac Actually Treats
- Nepafenac is specifically indicated for preventing pseudophakic cystoid macular edema (PCME) after cataract surgery in diabetic patients, particularly those with diabetic retinopathy 1
- It works by blocking cyclooxygenase enzymes to reduce prostaglandin production and inflammation following surgical trauma 1
- Nepafenac has superior ocular penetration compared to other NSAIDs, achieving therapeutic levels in the retina and choroid 1
What Moderate NPDR Actually Requires
- Moderate NPDR is characterized by hemorrhages/microaneurysms greater than standard photograph 2A, and/or soft exudates, venous beading, or IRMA, but less than severe NPDR 2
- Observation with optimization of systemic factors (glycemic control, blood pressure) is the standard approach for moderate NPDR without macular edema 2
- Laser photocoagulation is NOT recommended for mild or moderate NPDR 2
Evidence-Based Treatment for Moderate NPDR
Current Standard of Care
- Anti-VEGF therapy for non-proliferative diabetic retinopathy (including moderate NPDR) has been shown to reduce progression to proliferative disease and diabetic macular edema, but has NOT been shown to improve visual outcomes over 2 years and is therefore NOT routinely recommended 2
- The clinical indications for anti-VEGF use in moderate NPDR remain unknown and depend on systemic glucose control and compliance with follow-up 2
When to Escalate Treatment
- Promptly refer patients with severe NPDR or any proliferative diabetic retinopathy to an ophthalmologist 2
- Treatment becomes necessary when retinopathy progresses to severe NPDR or proliferative stages with high-risk characteristics 2
Clinical Context for Nepafenac Use
The Only Scenario Where Nepafenac is Relevant
- If your patient with moderate NPDR is undergoing cataract surgery, then prophylactic nepafenac should be considered to prevent PCME 1
- Diabetes mellitus causes breakdown of the blood-retinal barrier, increasing PCME risk after cataract surgery 1
- Nepafenac 0.3% once-daily dosing may improve compliance compared to other formulations 1
Important Safety Considerations
- Use nepafenac carefully in patients with compromised corneas, severe dry eye, or penetrating grafts 1
- Topical NSAIDs are more cost-effective for PCME prevention than treating established macular edema with invasive injections 1
Bottom Line Algorithm
For moderate NPDR management:
- Optimize systemic glycemic control and blood pressure 2
- Monitor with annual dilated eye examinations 2
- Do NOT use nepafenac—it treats surgical inflammation, not diabetic retinopathy 1
- Reserve anti-VEGF therapy for progression to center-involved diabetic macular edema or proliferative disease 2
Nepafenac only enters the picture if cataract surgery is planned 1