Vitreous Nonsteroidal Antiinflammatory Drug Concentrations and Prostaglandin E2 Levels in Vitrectomy Patients Treated With Ketorolac 0.4%, Bromfenac 0.09%, and Nepafenac 0.1%

Abstract

All three NSAIDs penetrated into the vitreous cavity. Topical therapy with ketorolac may lower preoperative vitreous prostaglandin E(2) levels, which may have a clinical impact on the management of prostaglandin-mediated diseases, including cystoid macular edema.

Prospective Randomized Controlled Trial of Combination Ranibizumab (Lucentis) and Bromfenac (Xibrom) for Neovascular Age-Related Macular Degeneration

“…13,14 Retinal/vitreous levels have also been investigated after topical administration and found to be within the therapeutic index. 12 These agents also appear to lower endogenous VEGF levels. 22 There is a strong biologic rationale to suggest that combination with current intravitreally delivered anti-VEGF agents would have positive synergism.…”

“…[9][10][11] Nonsteroidal antiinflammatory agents would be an attractive alternative because they can be delivered topically, achieve therapeutic levels in the retina, and have minimal complications or side effects. 12,13 Nonsteroidal antiinflammatory agents have been used to treat cystoid macular edema in the post-cataract extraction setting and off-label for cystoid macular edema of other etiologies. 14 In recent years, 2 retrospective short-term studies have been published regarding the use of one such agent, bromfenac (0.09%) (Xibrom; ISTA Pharmaceuticals, Inc, Irvine, CA) given in combination with anti-VEGF therapy.…”

Prospective randomised clinical trial to evaluate the safety and efficacy of nepafenac 0.1% treatment for the prevention of macular oedema associated with cataract surgery in patients with diabetic retinopathy

“…Intraocular hydrolases in the iris, ciliary body and retina convert nepafenac to amfenac, which is a potent inhibitor of cyclo-oxygenase activity 15 16. Amfenac has high ocular bioavailability in the aqueous humour, and in the vitreous 15 17. The safety and efficacy of an extended 90-day course of nepafenac 0.1% for the prevention of MO associated with cataract surgery in patients with DR is supported by the findings of a previously reported randomised, double-masked, vehicle-controlled clinical trial 18…”

Comparative Study of Intravitreal Ranibizumab with and Without Nepafenac Eye Drops for Center Involving Diabetic Macular Edema

“…In ophthalmology, topical NSAIDs are used to stabilize pupillary dilation during intraocular surgery and to treat allergic conjunctivitis and postoperative inflammation, pain and cystoid macular edema (CME). (12)(13)(14)(15)(16)(17) If an NSAID can penetrate to the retina, it could possibly reduce vascular permeability by inhibiting the inflammatory cascade. Based on this hypothesis, patients with DME may benefit from topical nepafenac 0.1% in an attempt to reduce the edema and improve vision.…”