Bromfenac versus nepafenac for pain management following transepithelial photorefractive keratectomy

PURPOSE: To compare the efficacy of two topical NSAID eye drops, Bromfenac and Nepafenac, in reducing postoperative pain following transepithelial photorefractive keratectomy (t-PRK). METHODS: A total of 119 patients undergoing bilateral t-PRK were divided into three groups: Nepafenac (n = 40), Bromfenac (n = 40), or control (n = 39). Nepafenac 0.1% three times daily or Bromfenac 0.07% twice daily, initiated two days preoperatively and continued for three days postoperatively. The control group received systemic paracetamol (500 mg) and ibuprofen (150 mg) tablets as needed. RESULTS: Overall, both Nepafenac and Bromfenac groups showed significantly lower mean pain levels compared with control group (mean difference = -2.77; 95% CI: -3.63 to - 1.91; p < 0.001, and mean difference = -2.22; 95% CI: -3.01 to -1.43; p < 0.001, respectively). Bromfenac was significantly superior to control only on days 1, 3, and 4. No statistically significant difference in mean pain levels was observed between Bromfenac and Nepafenac groups (mean difference = -0.55; 95% CI: -1.45 to 0.35; p = 0.234). While Nepafenac showed better early symptom control in pain and discomfort (stinging, tearing and light sensitivity), particularly in the first two postoperative days, Bromfenac had a better effect on ocular discomfort in the later postoperative phase on days 4 and 5. Both demonstrated comparable overall tolerability compared to the control. CONCLUSION: Both Nepafenac and Bromfenac significantly reduced postoperative pain following t-PRK compared to systemic analgesia. These findings support the use of topical NSAIDs in optimizing post-PRK pain management.