Central Macular Thickness, Subfoveal Choroidal Thickness, and Choroidal Vascularity Index After Phacoemulsification: Bromfenac versus Ketorolac

Purpose: To evaluate the exploratory effects of topical bromfenac 0.1% and ketorolac 0.45% on the posterior segment following cataract surgery, focusing on the choroidal vascularity index (CVI) as a sensitive biomarker, and to explore the potential impact of different dosing regimens. Methods: This retrospective cohort study included 105 eyes (47 in the ketorolac group and 58 in the bromfenac group) that underwent uncomplicated phacoemulsification. Subgroups were stratified by dosing duration: Pre-only (no postoperative NSAID) and Pre+Post (one-month postoperative maintenance). Central macular thickness (CMT), subfoveal choroidal thickness (SCT), and CVI (total area [CVI Total] and central 1,500 µm subfield [CVI 1500]) were analyzed using enhanced depth imaging optical coherence tomography at baseline and one month postoperatively. Results: Both drug groups showed comparable visual improvements and intraocular pressure reductions. Postoperatively, CMT and CVI significantly increased from baseline in both groups, while SCT increased significantly only in the bromfenac group (p = 0.003). Direct inter-group comparisons revealed no significant differences in the magnitude of anatomical changes (Δ). However, exploratory subgroup analysis showed that bromfenac maintenance therapy (Pre+Post) was associated with smaller increases in ΔCVI Total (0.3 ± 3.1% vs. 2.1 ± 3.6%; p = 0.027) and ΔCVI 1500 (0.3 ± 3.8% vs. 2.2 ± 4.0%; p = 0.044) compared to the Pre-only regimen, a trend not observed in CMT or SCT. Multivariable regression identified higher preoperative baseline values as independent predictors for smaller anatomical increases. Crucially, dosing duration independently predicted ΔCVI Total (p = 0.046), with maintenance therapy being associated with attenuated CVI increases. Conclusions: Prophylactic bromfenac and ketorolac demonstrated comparable overall efficacy in managing postoperative inflammation following cataract surgery. In this exploratory study, bromfenac maintenance therapy was associated with smaller postoperative CVI changes, suggesting a potential role for continued NSAID use in modulating early choroidal microvascular responses.