The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E₂ Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy

Abstract

Purpose To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. Methods This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. Results Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. Conclusion Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.

Application of Femtosecond Laser in Challenging Cataract Cases

“…Thus, FLACS can potentially be associated with increased intracameral inflammation and decreased pupil diameter compared with conventional cataract surgery 79–86 . Preoperative administration of topical nonsteroidal anti-inflammatory drugs may prevent the surge of prostaglandins and reduce intracameral inflammation and miosis 85,88 . A small pupil can be an obstacle for FLACS because mydriation of at least 7 mm is required for FSL pretreatment 28 .…”

“…[79][80][81][82][83][84][85][86] Preoperative administration of topical nonsteroidal antiinflammatory drugs may prevent the surge of prostaglandins and reduce intracameral inflammation and miosis. 85,88 A small pupil can be an obstacle for FLACS because mydriation of at least 7 mm is required for FSL pretreatment. 28 However, it is not an absolute contraindication for FLACS as mechanical pupil dilation can be attained using iris retractors or pupil expanders.…”

Vitreous Prostaglandin E2 Changes After Topical Administration of Diclofenac 0.1%, Indomethacin 0.5%, Nepafenac 0.3%, and Bromfenac 0.09%

“…Furthermore, NSAIDs administration had also been demonstrated to reduce postoperative pain and inflam-mation after vitreoretinal surgery when compared with placebo 33 and corticosteroids 15,34 A growing body of scientific evidence suggests a role of PGs in several retinal diseases. [8][9][10][11][12][13] In several experimental systems, the inhibition of the COX enzyme can increase the efficacy of antiangiogenic treatments by suppressing vascular endothelial growth factor and angiogenesis.…”

“…6,7 Recently, several scientific evidences suggest a role of PGs in the pathogenesis of diabetic retinopathy, age-related macular degeneration, intraocular tumors, and other retinal diseases. [8][9][10][11][12][13] Although the NSAIDs bioavailability in the aqueous humor has been widely demonstrated, [14][15][16][17] the achievement of therapeutic levels in the posterior segment is less evident and still debated. The effect of NSAIDs in preventing posterior segment inflammation could be argued by dosing both the NSAID and prostaglandin E 2 (PGE 2 ) concentration into the vitreous after topical administration.…”

Management of inflammation after the cataract surgery

“…However, pretreatment with NSAIDs before FLACS reduces inflammatory markers in the aqueous [83][84][85], but unfortunately these studies did not evaluate flare or retinal thickness. When considering PCME, it was also proved that 3 days of pretreatment with 0.45% ketorolac decreases PGE2 by approximately 15% in the vitreous cavity while much higher levels of prostaglandin inhibition were seen with 7 days of pretreatment with topical indomethacin, bromfenac and nepafenac [86].…”