Longitudinal Changes in Subfoveal Choroidal Thickness After Phacoemulsification and the Effect of Topical Nepafenac 0.3%

PurposeThis study aimed to evaluate longitudinal changes in subfoveal choroidal thickness (SFCT) after uncomplicated phacoemulsification and to assess whether topical nepafenac 0.3% modifies the postoperative SFCT response. MethodsThis prospective observational comparative study included 30 eyes of 30 patients: 15 received standard postoperative therapy (Group A), and 15 received standard therapy plus nepafenac 0.3% once daily (Group B).Postoperative medication was determined independently by the operating surgeon according to routine clinical practice and was not assigned by the investigators for research purposes.SFCT was measured preoperatively and at postoperative day 1 (POD1), week 1, and week 12 using enhanced-depth imaging optical coherence tomography (EDI-OCT).The primary longitudinal analysis used a linear mixed-effects model with patient-level random intercepts and fixed effects for treatment group, time, group-by-time interaction, age, sex, and axial length.Secondary analyses compared changes from baseline with 95% confidence intervals (CIs). ResultsMean preoperative SFCT was 207.8 ± 18.5 µm in Group A and 194.3 ± 18.9 µm in Group B. SFCT increased in both groups, peaking at week 1 (245.3± 14.6 µm and 232.7 ± 21.1 µm, respectively) and declining partially by week 12 (231.5 ± 17.6 µm and 215.0 ± 22.1 µm).SFCT demonstrated a highly significant longitudinal change following phacoemulsification (Wald χ²=97.0;p<0.001).However, the group-by-time interaction was not significant (Wald χ²=0.65;p=0.884).Between-group differences in change from baseline (Group B minus Group A) were -2.07 µm at POD1 (95% CI, -8.97 to 4.84; p=0.542), 0.87 µm at week 1 (95% CI, -12.61 to 14.35; p=0.896), and -3.07 µm at week 12 (95% CI, -13.75 to 7.62; p=0.559). ConclusionPhacoemulsification produced a significant longitudinal increase in SFCT, with peak thickening at one week and persistent elevation above baseline at 12 weeks.In this cohort, addition of topical nepafenac 0.3% once daily did not detect any statistically significant difference in the longitudinal SFCT response compared with standard postoperative therapy alone.Larger, adequately powered randomized studies are required to determine whether a clinically meaningful treatment effect exists.