Efficacy and safety of bromfenac for the treatment of corneal ulcer pain

Topical bromfenac as adjunctive treatment with intravitreal ranibizumab for diabetic macular edema

PURPOSE

To determine the safety and efficacy of adding topical bromfenac 0.09% in the treatment of diabetic macular edema.

METHODS

Seventy patients (70 eyes) with center involved diabetic macular edema with macular thickness (300-500 μm) were included. Patients were divided randomly into two groups: 35 eyes in each group. Both groups were treated with intravitreal ranibizumab monthly for three consecutive months. Bromfenac 0.09% eye drops twice daily was added to the treatment of study group for six months from commencement of treatment. The efficacy of topical bromfenac was evaluated by comparing both groups through follow-up period as regards to visual acuity, central and average thickness and the need for re-injection.

RESULTS

Patients treated with topical bromfenac in addition to intravitreal ranibizumab revealed significant improvement in visual acuity, more reduction in central and average macular thickness and less tendency to need reinjection compared to those treated with ranibizumab alone (p 0.013, p 0.010 and p 0.022, respectively). No side effects was encountered with the use of topical bromfenac.

CONCLUSION

Topical bromfenac 0.09% twice a day could enhance and sustain the efficacy of intravitreal ranibizumab in the treatment of diabetic macular edema without increasing the incidence of corneal side effects.

[Features of anti-inflammatory therapy of bacterial corneal ulcers]

Purpose - to evaluate clinical effectiveness and safety of anti-inflammatory therapy for the treatment of bacterial corneal ulcers.

MATERIAL AND METHODS

The study included 49 patients treated for bacterial corneal ulcers. Main study patients were divided into two subgroups - the 1st group in addition to conventional treatment received parabulbar injections of 0.3 ml Dexamethasone (4 mg/ml) from the first day of treatment and during the entire period. Patients of the 2nd group, in addition to parabulbar injections of 0.3 ml Dexamethasone (4 mg/ml), received instillation of 0.09% bromfenac (Broxinac) once a day from the first day of therapy and for the entire treatment period. The control group consisted of 17 subjects who underwent standard treatment. The study used a scale for assessing the severity of corneal ulcers. Along with standard ophthalmological examination, all patients were assessed for the ulcer defect using optical coherence tomography (OCT) to measure the diameter of the corneal ulcer and the depth coefficient.

RESULTS

In the first and second groups, the therapy algorithm has reduced the duration of treatment and hospitalization, promoted rapid epithelization and a reduction in the depth of the ulcer, led to less rough scarring of the cornea reducing corneal neoangiogenesis, and helped achieve higher visual acuity as a result of treatment.

CONCLUSION

The use of a corticosteroid drug (Dexamethasone) for bacterial corneal ulcers reduces the duration of treatment and hospitalization and improves functional results of the treatment. Bromfenac 0.09% (Broxinac) was effective in the treatment of pain associated with bacterial corneal ulcer, but did not delay corneal epithelialization nor cause any corneal adverse events.

Use of topical bromfenac for treating ocular pain and inflammation beyond cataract surgery: a review of published studies

Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative inflammation and pain following cataract surgery and for treatment and prophylaxis of pseudophakic cystoid macular edema (CME). Bromfenac is a brominated NSAID with strong in vitro anti-inflammatory potency. Like other ophthalmic NSAIDs, bromfenac is often used outside of the cataract surgery setting. This paper provides an overview of bromfenac’s preclinical ocular pharmacology and pharmacokinetics, followed by a review of 23 published clinical studies in which various marketed bromfenac formulations were used for conditions other than cataract surgery or pseudophakic CME. These include: post-refractive eye surgery; macular edema associated with diabetes, uveitis, or retinal vein occlusion; inflammation associated with age-related macular degeneration; pain related to intravitreal injections; and other ocular anterior segment and surface disorders with an inflammatory component. The published evidence reviewed supports the safety and effectiveness of bromfenac in these additional ophthalmic indications. Bromfenac was well tolerated when given alone or in combination with intravitreal anti-vascular endothelial growth factor agents, topical corticosteroids, or topical mast-cell stabilizers. The most common adverse event reported was ocular irritation. No serious adverse events (ie, corneal epithelial disorders) were reported, although the majority of studies did not systematically evaluate potential side effects. Corneal complications, such as melts reported with diclofenac and ketorolac, were not observed with bromfenac in the studies. In summary, published study data support the clinical utility of bromfenac in various ocular disorders beyond post-cataract surgery. Additional studies are warranted to further define the potential role of bromfenac ophthalmic solution in clinical practice.

EFFECT OF BROMFENAC ON PAIN RELATED TO INTRAVITREAL INJECTIONS: A Randomized Crossover Study

PURPOSE

To evaluate the analgesic effect of bromfenac, a topically administered nonsteroidal antiinflammatory agent, in patients undergoing intravitreal injections (IVIs) of anti-vascular endothelial growth factor agents.

METHODS

A single center, prospective, randomized, double-blind, placebo-controlled, cross over interventional study. Patients scheduled to undergo IVI of anti-vascular endothelial growth factor were randomized to receive topical bromfenac or placebo before IVI. Pain perception was assessed using the short form of the McGill Pain Questionnaire. Pain intensity was evaluated with the visual analog scale, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity scores immediately and 6 hours postinjection.

RESULTS

Sixty-five patients (65 eyes) were enrolled in the study. Immediately after IVI, pain perception was statistically significant lower in patients treated with bromfenac compared with placebo as assessed by the visual analog scale pain score and the main component of the short form of the McGill Pain Questionnaire (P = 0.002 and 0.001, respectively). At 6 hours postIVI, pain was statistically significant lower in patients treated with bromfenac, according to the visual analog scale pain score, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity score (P < 0.001, <0.001, and P = 0.001, respectively). Multivariable regression analysis revealed that pain perception, as evaluated with the visual analog scale pain score immediately after IVI, was significantly lower in patients of older age, female patients and those with higher number of previous injections. Immediately after IVI, bromfenac seemed to be more effective in younger patients and in those who had already undergone an amount of injections.

CONCLUSION

Topical instillation of bromfenac significantly reduced the IVI-related pain immediately after and 6 hours postinjection.

Besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial keratitis: a retrospective safety surveillance study

PURPOSE

The objective of this study was to collect and evaluate retrospective safety information about the use of besifloxacin ophthalmic suspension 0.6% for the treatment of bacterial keratitis.

METHODS

This was a retrospective, postmarketing surveillance study conducted at 10 clinical centers in the United States. The study population included 142 patients treated with besifloxacin ophthalmic suspension 0.6% for bacterial keratitis in one or both eyes. For perspective, data on 85 patients treated at these centers with moxifloxacin ophthalmic solution 0.5% for bacterial keratitis were also included. The analysis was designed to measure the types and rates of adverse events (AEs) reported during the treatment of bacterial keratitis with besifloxacin ophthalmic suspension 0.6%. Other treatment outcomes of interest included the development of corneal scarring and corneal neovascularization, measured or presumed bacterial eradication, ending visual acuity, and duration of pain before and after treatment.

RESULTS

There was one reported AE of mild superficial punctate keratitis in a patient using besifloxacin ophthalmic suspension 0.6%. The difference in AE frequencies between groups was not significant (P>0.999). Additional treatment outcomes were similar for both groups. Limitations of this report include the retrospective nature of the study.

CONCLUSIONS

These retrospective data suggest that besifloxacin ophthalmic suspension 0.6% was well tolerated when included in the treatment of bacterial keratitis; no serious AEs were reported. A prospective clinical trial is needed to better isolate the contribution of besifloxacin to the therapeutic outcome and to confirm these observations.