Topical bromfenac for prevention and treatment of cystoid macular edema following cataract surgery: a review

Abstract

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, alone or in combination, have historically been used off label in the US to prevent and treat postoperative cystoid macular edema (CME). This literature review presents available data on the use of bromfenac 0.07% or 0.09% to prevent and treat CME following cataract surgery. Bromfenac is an NSAID approved to treat postoperative inflammation and reduce ocular pain following cataract surgery. Few cases of clinical CME were observed with bromfenac use in a total of 19 reviewed studies. There were no significant differences in CME incidence between bromfenac and corticosteroid-treated patients or between bromfenac- and bromfenac plus corticosteroid-treated patients. Bromfenac demonstrated comparable efficacy to other NSAIDs in preventing CME. Compared with corticosteroids, bromfenac alone or plus a corticosteroid showed similar or better efficacy in minimizing changes in retinal thickness and macular volume. In diabetic cataract surgery patients, bromfenac was comparable or superior to corticosteroids for minimizing changes in retinal thickness; also, combination therapy with bromfenac and corticosteroids may be associated with smaller changes in foveal thickness, macular thickness, and macular volume versus monotherapy with either treatment alone in this patient population. In two randomized, double-masked, placebo-controlled clinical trials with bromfenac 0.07%, CME was reported as an adverse event in 0.5% and 1.5% of patients receiving bromfenac and placebo, respectively. In an analysis of four placebo-controlled trials with bromfenac 0.09%, macular edema was reported in 0.7% and 1.4% of patients receiving bromfenac and placebo, respectively. When evaluated as treatment for acute or chronic CME, bromfenac was associated with improvement in visual acuity and reduction in retinal thickness, but few studies are available. Overall, published data suggest that bromfenac is safe and effective when used to prevent or treat CME. Large-scale placebo-controlled trials and greater standardization of CME measures are needed to establish optimal bromfenac regimens for the prophylaxis and treatment of CME following cataract surgery.

Nonsteroidal antiinflammatory drugs and treatment of cystoid macular edema

“…After 3 months, both treatment meth-ods resulted in a significant reduction in CME and significant improvement in visual acuity 18 . Studies comparing bromfenac with other NSAIDs observed no significant differences in the CME rates between bromfenac and nepafenac when given alone or in combination with corticosteroid 7,19 . Warren et al compared four topical NSAIDs (bromfenac 0,09% 2 times/day, diclofenac 0,1% 3 times/day, ketorolac 0,4% 3 times/day, nepafenac 0,1% 3 times/day) in patients with chronic pseudophakic CME.…”

“…Bromfenac 0,09%, has good ocular penetration with insignificant systemic reactions following topical administration. Bromfenac has been found to be more potent as a COX-2 inhibitor than diclofenac and ketorolac 7 . Studies have shown that nepafenac may be more potent than ketorolac or diclofenac.…”

Bromfenac Inhibits TGF-β1–Induced Fibrotic Effects in Human Pterygium and Conjunctival Fibroblasts

“…Bromfenac is a kind of NSAID, which is approximately three to four times more effective at inhibiting COX-2 in vitro as compared with other ophthalmic NSAIDs amfenac, ketorolac, and diclofenac. 27 Bromfenac is usually used to prevent macular edema and inflammation after cataract and complex ocular surgeries, [27][28][29] which is less toxic toward corneal epithelial cells. 30 Our study intended to explore whether bromfenac has the potential to prevent the excessive wound healing that takes place after the pterygium surgeries.…”

Alternative treatment methods in eyes with pseudophakic cystoid macular edema

“…The incidence of IGS has been reported 0.1-5% according to different reports, Several meta-analyses and systematic reviews have reported that a signi icant reduction in incidence of CME after cataract surgery with prophylactic use of topical nonsteroidal anti-in lammatory drugs (NSAID), including ketorolac 0.4%, bromfenac 0.1%, nepafenac 0.1% and diclofenac 0.1%. Topically applied NSAIDs reduce prostaglandin synthesis by inhibiting the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes [10][11][12][13][14]. Topical anti-glaucoma treatment rather than prostaglandin at least one week before surgery can reduced the risk of PCME development.…”

“…There is no standardized treatment protocol for Irvine-Gass syndrome due its multifactorial pathogenesis and spontaneous resolution in most of the cases. Spontaneous resolution without any treatment, may take weeks or months, so for patients, especially those who have vision-dependent occupations and live active lifestyles, treatment should start as early as possible [10][11][12][13].…”