Duration of Nepafenac Therapy After Cataract Surgery
Nepafenac should be used for 2 weeks after cataract surgery, starting 1 day before surgery and continuing through the first 2 postoperative weeks. 1
Standard Treatment Duration
- The FDA-approved regimen is 3 times daily for 15 days total: beginning 1 day prior to cataract surgery, continued on the day of surgery, and through the first 2 weeks of the postoperative period 1
- An additional drop should be administered 30-120 minutes before surgery 1
- The American Academy of Ophthalmology recommends topical NSAIDs (including nepafenac) for use within the first post-surgical month 2, 3
Clinical Evidence Supporting This Duration
- The 2-week duration is based on phase 3 clinical trials demonstrating that nepafenac 0.1% three times daily through postoperative day 14 significantly reduced inflammation (68.4% cure rate vs 34.0% for vehicle) and pain (91.0% pain-free vs 49.7% for vehicle) 4
- Multiple studies confirm efficacy is established by day 14, with nepafenac producing significantly more cures compared to placebo (76.3% vs 59.2%) at this timepoint 5
- Treatment failures were significantly reduced at all postoperative visits through day 14 when using the standard regimen 4
Integration with Other Post-Cataract Medications
- Nepafenac is used concurrently with topical corticosteroids (prednisolone acetate 1% four times daily, tapered over 3-5 weeks), but the NSAID duration is shorter 6
- When using multiple topical medications, administer them at least 5 minutes apart 1
- Preservative-free formulations are strongly preferred, especially in high-risk patients with dry eye disease, diabetes, or multiple medication use 6, 2
Follow-Up and Monitoring During Treatment
- Critical monitoring should occur on postoperative day 1 and during weeks 1-2 to check for infection, inflammation, dry eye, or ocular surface damage 2
- Treatment effect should be evaluated at 1 month post-surgery 2, 3
- The medication is discontinued after 2 weeks, but corticosteroid taper continues for several additional weeks 6
Important Caveats
- Do not extend nepafenac beyond 2 weeks routinely - the FDA label and clinical trials establish efficacy and safety for this specific duration 1, 4
- Nepafenac can cause delayed healing and corneal effects including keratitis, making prolonged use potentially harmful 1
- If inflammation persists beyond 2 weeks, this represents a treatment failure requiring reassessment rather than continued NSAID therapy 4