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Almasri M, Ismaiel A, Gavris I, Leucuta DC, Gavris MM, Nicoara SD. Topical NSAIDs impact on macular oedema and visual outcome after phacoemulsification: systematic review of RCTs with network meta-analysis. Eye (Lond) 2024:10.1038/s41433-024-03268-x. [PMID: 39095467 DOI: 10.1038/s41433-024-03268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/06/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024] Open
Abstract
The aim of this Network Meta-analysis was to compare the efficacy of the different topical Nonsteroidal anti-inflammatory drugs (NSAIDs) when added or not to topical steroids in preventing the thickening of the macula and their impact on visual acuity and intraocular pressure after phacoemulsification. Five electronic databases were searched, including PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov. Our primary outcome was one-month post-surgery visual outcome. We also considered change in Foveal thickness (FT) and Intraocular pressure (IOP) at one-month post-surgery. We summarized our analyses by calculating the mean differences (MD) with associated 95% confidence intervals (CI) using restricted maximum likelihood in random effects models for continuous outcomes. The methodological quality of the studies was assessed with Cochrane Collaboration's tool. The network meta-analysis was conducted using frequentist approach considering Nepafenac 0.1% as a reference medication. Eleven Randomized controlled trials (RCTs) including 2175 subjects were selected for quantitative analysis. At one-month post-surgery, Bromfenac had statistically significant better visual acuity compared to Nepafenac 0.1% (p < 0.001), regarding FT, Nepafenac 0.3% had the least increase in FT compared to Nepafenac 0.1% (p = 0.09), regarding IOP, Diclofenac had the lowest IOP. No significant results regarding FT and IOP. Interestingly Ketorolac had the worst results regarding BCVA and IOP, and came last but one for FT. Overall, our network meta-analysis demonstrated that Bromfenac was associated with a significant improvement in visual acuity compared to Nepafenac 0.1% at one-month following cataract surgery, while Nepafenac 0.3% was associated with the least increase in foveal thickness.
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Affiliation(s)
- Malaz Almasri
- Department of Ophthalmology of Military Emergency Hospital "Dr. Constantin Papilian", Cluj-Napoca, 400132, Romania
- Department of Ophthalmology, "Iuliu Hatieganu" University of Medicine and Pharmacy, ClujNapoca, 400394, Romania
| | - Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400006, Romania
| | - Iulia Gavris
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 400349, Romania.
| | - Monica M Gavris
- Department of Ophthalmology of Military Emergency Hospital "Dr. Constantin Papilian", Cluj-Napoca, 400132, Romania
| | - Simona Delia Nicoara
- Department of Ophthalmology, "Iuliu Hatieganu" University of Medicine and Pharmacy, ClujNapoca, 400394, Romania
- Department of Ophthalmology of County Emergency Hospital, Cluj-Napoca, 400394, Romania
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Mian OT, Asif H, Sandhu U, Multani K, Farooq AV, Ding K, Riaz KM. Noninfectious Outcomes of Intravitreal Antibiotic Steroid Injection and Topical Nonsteroidal Antiinflammatory Drugs Versus Triple Drop Therapy After Cataract Surgery. Am J Ophthalmol 2024; 260:37-48. [PMID: 37944685 DOI: 10.1016/j.ajo.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To compare noninfectious outcomes of intravitreal antibiotic steroid (IVAS) injection (moxifloxacin-triamcinolone) and postoperative topical nonsteroidal antiinflammatory drugs (NSAID) with a standard 3-drop therapy (TDT) regimen (topical antibiotic, steroid, and NSAID) in patients after cataract surgery. DESIGN Retrospective comparative clinical cohort study. METHODS In 3 study centers in the United States, a total of 2143 eyes (N = 2143 patients) underwent cataract surgery with IVAS-NSAID or TDT between 2017 and 2022. Preoperative data were included, including patients' age, iris color, medical history, and ocular history. Postoperative data, including best-corrected visual acuity, intraocular pressure (IOP), and the need for IOP-lowering medications, were recorded at 1-week, 1-month, and 6-month time points. The primary outcome measures were postoperative complications, defined as persistent anterior chamber inflammation, persistent corneal edema (PCE), rebound inflammation, and cystoid macular edema, were compared between the 2 groups. RESULTS There were 1079 eyes in the IVAS-NSAID group and 1064 eyes in the TDT group. Best-corrected visual acuity and IOP were similar between IVAS-NSAID and TDT eyes at all time points. A portion (11.6%) of TDT eyes experienced postoperative complications compared with 6.5% in IVAS-NSAID eyes (P < .001). Femtosecond laser-assisted cataract surgery was associated with increased rates of PCE in IVAS-NSAID eyes, and eyes with dark irides had a higher incidence of cystoid macular edema, PCE, and rebound inflammation in the IVAS-NSAID group. CONCLUSION The IVAS-NSAID regimen overall had similar postoperative outcomes and fewer complications compared with the TDT regimen. IVAS-NSAID may be considered a safe alternative to topical regimens in non-femtosecond laser-assisted cataract surgery and patients with light irides.
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Affiliation(s)
- Osamah T Mian
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Hassaan Asif
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Umar Sandhu
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Karan Multani
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Asim V Farooq
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Kai Ding
- Department of Biostatistics and Epidemiology (K.D.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kamran M Riaz
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma.
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Heath M, McDonald MC, Murphy DA, Shah SV, Shah S, Ding K, Riaz KM. Fill levels, cost comparisons, and expulsion force requirements of commonly used topical ophthalmic nonsteroidal anti-inflammatory drugs. J Cataract Refract Surg 2023; 49:747-753. [PMID: 36853852 DOI: 10.1097/j.jcrs.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) commonly perioperatively in the United States. SETTING Tertiary care academic medical center. DESIGN Prospective laboratory investigation. METHODS 8 commercially available NSAIDs (3 branded, 5 generic) were tested: branded bromfenac 0.07%, generic bromfenac 0.09%, diclofenac 0.1%, flurbiprofen 0.03%, generic ketorolac 0.5%, branded ketorolac 0.5%, ketorolac 0.47%, and branded nepafenac 0.3%. 10 bottles of each medication were tested, with an additional bottle tested for expulsion force requirements. A double-blinded method was used to measure the actual bottle fill volume and number of drops per bottle. The total cost per drop was calculated using published cash prices. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using the Kruskal-Wallis test, followed by pairwise comparisons with the Dwass, Steel, Critchlow-Fligner Method. RESULTS 2 branded NSAIDs (bromfenac and nepafenac) had slightly lower-than-sticker volumes while generics other than ketorolac had higher-than-sticker volumes. Diclofenac and branded bromfenac had the highest and lowest adjusted number of drops respectively. Generic bromfenac and generic ketorolac had the highest and lowest adjusted volume compared with sticker volume respectively. Branded bromfenac was the most expensive medication, while generic diclofenac was the least expensive. Force expulsion requirements varied significantly among generic and branded NSAIDs. CONCLUSIONS Volume fill levels, patient-incurred costs, and expulsion force requirements per bottle of topical NSAID medications vary significantly. Surgeons may wish to consider these factors when deciding how best to use these medications perioperatively.
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Affiliation(s)
- Michael Heath
- From the Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Heath, McDonald, Murphy, Riaz); Oklahoma School of Science and Mathematics, Oklahoma City, Oklahoma (S.V. Shah, S. Shah); Hudson College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma (Ding)
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Bezatis A, Georgou I, Dedes J, Theodossiadis P, Chatziralli I. Nepafenac in cataract surgery. Clin Exp Optom 2021; 105:263-267. [PMID: 34210237 DOI: 10.1080/08164622.2021.1945412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in routine cataract surgery has been established since decades. Topical NSAIDs have been shown to reduce postoperative ocular inflammation and pain, preserve intraoperative mydriasis, and reduce the risk of postoperative cystoid macular oedema, whilst carrying a very low side-effect profile. Nepafenac is one of the currently available topical NSAIDs. The studies have shown that is has a high ocular penetration, allowing for potentially better results than other NSAIDs. This review gathers the current literature on the role of nepafenac in cataract surgery aiming to help surgeons maximise the benefits of its use to achieve improved surgical outcomes.
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Affiliation(s)
- Athanasios Bezatis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Georgou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Dedes
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2 Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Sun Y, Huffman K, Freeman WR, Cheng L. Single subconjunctival injection formulation using sol-gel mesoporous silica as a controlled release system for drop-free post-cataract surgery care. J Cataract Refract Surg 2020; 46:1548-1553. [PMID: 32818352 PMCID: PMC7644604 DOI: 10.1097/j.jcrs.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a mesoporous silica drug delivery system and target drop-free care after cataract surgery with a single subconjunctival injection. SETTING Laboratory. DESIGN Experimental animal study. METHODS Ketorolac was infiltration-loaded into sol-gel mesoporous silica particles encapsulated with poly(allylamine hydrochloride) and poly(sodium 4-styrenesulfonate) using a layer-by-layer adsorption technique (SG-Ket-LBL). The formulation was subjected to an in vitro and in vivo drug release study in addition to ocular toxicology evaluation. RESULTS Thermogravimetric analysis revealed that the drug loading efficiency was 4.4% for the SG-Ket-LBL particles. The in vivo safety study demonstrated that the formulation was well tolerated after subconjunctival injection and aqueous humor pharmacokinetics showed sustained therapeutic drug release for the targeted time window of 6 to 8 weeks. CONCLUSIONS Findings indicated that sol-gel mesoporous silica could be used as a drug carrier for subconjunctival administration. The tested formulation, SG-Ket-LBL, provided therapeutic ketorolac for 6 to 8 weeks, which might be used for a single subconjunctival injection to replace nonsteroidal anti-inflammatory drug eyedrops after cataract surgery.
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Affiliation(s)
- Yaoyao Sun
- From the Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, California, USA. Y. Sun is now at the Department of Ophthalmology, Ophthalmology & Optometry Center, Peking University People's Hospital, Beijing, China
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Kaplan RI, Drinkwater OJ, Lee RH, Chod RB, Barash A, Giovinazzo JV, Gologorsky D, Jansen ME, Rosen RB, Gentile RC. Pain Control after Intravitreal Injection Using Topical Nepafenac 0.3% or Pressure Patching: A Randomized, Placebo-Controlled Trial. Ophthalmol Retina 2019; 3:860-866. [PMID: 31221565 DOI: 10.1016/j.oret.2019.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Pain after an intravitreal injection (IVI) can last up to 7 days and negatively impacts the patient's experience, potentially reducing treatment compliance. We prospectively evaluated topical nepafenac 0.3% suspension and patching for the reduction of pain after IVI. DESIGN Randomized controlled trial. PARTICIPANTS Sixty patients receiving an IVI of bevacizumab, aflibercept, or triamcinolone acetonide in 1 eye. METHODS Participants were randomized equally to receive either a single drop of nepafenac 0.3%, a pressure patch for 2 hours, or a single drop of preservative-free artificial tears (control group). A single-blinded placebo-controlled design was used to mask the topical treatment used. Pain was assessed using the Numeric Pain Rating Scale that ranged from 0 to 10 (horizontal pain scale). Because pain scores were not normally distributed, statistical analysis was performed using a nonparametric randomization-based analysis of covariance. MAIN OUTCOME MEASURE Pain scores. RESULTS Fifty-six and 53 patients of the 60 patients enrolled completed the 6- and 24-hour follow-ups, respectively. Numeric Pain Rating Scale scores at 6 and 24 hours after IVI were lower in the nepafenac group (0.8±0.3 and 0.1±0.1, respectively; n = 18) and the patching group (1.3±0.4 and 0.4±0.2, respectively; n = 19) compared with the control group (2.5±0.6 and 0.9±0.4, respectively; n = 19). After controlling for age, gender, number of prior injections, and physician administering the injection, patients in the nepafenac group reported significantly lower pain scores than those in the control group at 6 hours (1.3±0.6 less; P = 0.047) and 24 hours (0.7±0.3 less; P = 0.047). Although the patching group reported lower pain scores than the control group, this was not statistically significant (6 hours, P = 0.24; 24 hours, P = 0.29). CONCLUSIONS Nepafenac 0.3% was effective as a single drop in reducing pain at 6 and 24 hours after IVI compared with placebo. Limited patching was associated with lower pain scores than placebo, but the difference was not statistically significant. Additional studies are needed to determine the most effective method to maximize the patient's experience after an IVI without sacrificing outcomes.
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Affiliation(s)
- Richard I Kaplan
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Owen J Drinkwater
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York; Weill-Cornell Medical College, New York, New York
| | - Rachel H Lee
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Ross B Chod
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Alexander Barash
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Jerome V Giovinazzo
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Daniel Gologorsky
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Michael E Jansen
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Richard B Rosen
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | - Ronald C Gentile
- Retina Service, Department of Ophthalmology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York; Department of Ophthalmology, NYU Winthrop Hospital, Mineola, New York.
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Pendke S, Patil P, Bandyopadhyay M, Ganguly P. A comparative study between topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients attending a tertiary care center in West Bengal. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2019. [DOI: 10.4103/jcor.jcor_62_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ylinen P, Taipale C, Lindholm JM, Laine I, Holmström E, Tuuminen R. Postoperative management in cataract surgery: nepafenac and preservative-free diclofenac compared. Acta Ophthalmol 2018; 96:853-859. [PMID: 30284393 DOI: 10.1111/aos.13843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Current cataract surgery guidelines recommend routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing pseudophakic cystoid macular oedema (PCME). Here, we compare the clinical efficacy and tolerability of two potent NSAIDs, nepafenac and preservative-free diclofenac following cataract surgery. METHODS Randomized, double-blind, prospective single-centre study. Ninety-six eyes of 95 patients undergoing routine cataract surgery were randomized 1:1 either to nepafenac (Nevanac, 1 mg/ml) or diclofenac (Dicloabak, 1 mg/ml) for 3 weeks. Seventy-three patients accounting for 73 eyes completed the entire follow-up. Aqueous flare and central retinal thickness (CRT) analysis were conducted preoperatively and at control visits 28 days and 3 months after surgery. A structured home questionnaire and interview were used to record any adverse effects of the topical medications, subjective visual recovery and the dispenser's ease of use. RESULTS No differences were observed between the groups for aqueous flare, CRT, speed of recovery or visual acuity gain. Seven patients (16%) on nepafenac and 20 patients (48%) on preservative-free diclofenac reported symptoms related to topical use of NSAID medications (p = 0.001). CONCLUSION No differences in clinical efficacy were found between potent NSAIDs, while tolerability might be an issue.
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Affiliation(s)
- Petteri Ylinen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Claudia Taipale
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Juha-Matti Lindholm
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Ophthalmology; Helsinki University Hospital; Helsinki Finland
| | - Ilkka Laine
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Department of Automation and Electrical Engineering; Aalto University; Helsinki Finland
| | - Emil Holmström
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Transplantation Laboratory; University of Helsinki; Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group; University of Helsinki; Helsinki Finland
- Unit of Ophthalmology; Kymenlaakso Central Hospital; Kotka Finland
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Shelley H, Grant M, Smith FT, Abarca EM, Jayachandra Babu R. Improved Ocular Delivery of Nepafenac by Cyclodextrin Complexation. AAPS PharmSciTech 2018; 19:2554-2563. [PMID: 29948988 DOI: 10.1208/s12249-018-1094-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023] Open
Abstract
Nepafenac is a nonsteroidal anti-inflammatory drug (NSAID), currently only available as 0.1% ophthalmic suspension (Nevanac®). This study utilized hydroxypropyl-β-cyclodextrin (HPBCD) to increase the water solubility and trans-corneal permeation of nepafenac. The nepafenac-HPBCD complexation in the liquid and solid states were confirmed by phase solubility, differential scanning calorimetry (DSC), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and nuclear magnetic resonance spectroscopy (NMR) analyses. Nepafenac 0.1% ophthalmic solution was formulated using HPBCD (same pH and osmolality as that of Nevanac®) and pig eye trans-corneal permeation was studied versus Nevanac®. Furthermore, nepafenac content in cornea, sclera, iris, lens, aqueous humor, choroid, ciliary body, retina, and vitreous humor was studied in a continuous isolated pig eye perfusion model in comparison to the suspension and Nevanac®. Permeation studies using porcine corneas revealed that the solution formulation had a permeation rate 18 times higher than Nevanac®. Furthermore, the solution had 11 times higher corneal retention than Nevanac®. Drug distribution studies using porcine eyes revealed that the solution formulation enables detectable levels in various ocular tissues while the drug was undetectable by Nevanac®. The ocular solution formulation had a significantly higher drug concentration in the cornea compared to the suspension or Nevanac®.
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Rodríguez-García A, Hernández-Camarena JC, López-Jaime GR, Nava-García JA. Effect of Topical Nonsteroidal Anti-inflammatory Drugs on Pupillary Size During Uncomplicated Cataract Surgery. J Refract Surg 2017; 33:236-242. [DOI: 10.3928/1081597x-20161206-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022]
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Zhao X, Xia S, Wang E, Chen Y. Comparison of the efficacy and patients' tolerability of Nepafenac and Ketorolac in the treatment of ocular inflammation following cataract surgery: A meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0173254. [PMID: 28253334 PMCID: PMC5333896 DOI: 10.1371/journal.pone.0173254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
As a new ophthalmic non-steroidal anti-inflammatory drug (NSAID) with prodrug structure, Nepafenac was supposed to have a better efficacy than conventional NSAIDs both in patients’ tolerability and ocular inflammation associated with cataract surgery. However, many current studies reached contradictory conclusions on the superiority of Nepafenac over Ketorolac. The objective of our study is to evaluate the efficacy and patients’ tolerability of Nepafenac and Ketorolac following cataract surgery. To clarify this, we conducted a meta-analysis of randomized controlled trials. Eleven articles were included in this study. The dataset consisted of 1165 patients, including 1175 cataract surgeries. Among them, 574 patients were in the Nepafenac group and 591 in the Ketorolac group. Our analysis indicated that these two drugs were equally effective in controlling post cataract surgery ocular inflammation, reducing macular edema, achieving a better visual ability and maintaining intraoperative mydriasis during cataract surgery. However, Nepafenac was more effective than Ketorolac in reducing the incidence of postoperative conjunctival hyperemia and ocular discomfort. This meta-analysis indicated that topical Nepafenac is superior to Ketorolac in patients’ tolerability following cataract surgery. However, these two drugs are equally desirable in the management of anterior chamber inflammation, visual rehabilitation and intraoperative mydriasis. Given the limitations in our study, more researches with larger sample sizes and focused on more specific indicators such as peak aqueous concentrations of drugs or PEG2 levels are required to reach a firmer conclusion.
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Affiliation(s)
- Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Song Xia
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Erqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
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Porela-Tiihonen S, Kokki H, Kaarniranta K, Kokki M. Recovery after cataract surgery. Acta Ophthalmol 2016; 94 Suppl 2:1-34. [PMID: 27111408 DOI: 10.1111/aos.13055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cataract surgery is the most common ophthalmological surgical procedure, and it is predicted that the number of surgeries will increase significantly in the future. However, little is known about the recovery after surgery. The first aim of this study was to evaluate the prevalence, severity and duration of pain and other ocular discomfort symptoms experienced after cataract surgery. The other objectives were to identify the factors associated with lower postoperative patient satisfaction and to measure the effect of cataract surgery on patients' health-related quality of life (HRQoL) and visual function in everyday life. The study design was a prospective follow-up study. The course of the recovery and the presence of ocular symptoms were evaluated by interviewing the patients via a questionnaire at 1 day, 1 week, 6 weeks and one year after surgery The visual functioning in everyday life was measured with Visual Functioning Index VF-7 and Catquest-9SF-questionnaires and furthermore the HRQoL was measured with the 15D-instrument before surgery and at 12 months after surgery. The patients returned the questionnaires by mail and were interviewed in the hospital on the day of the surgery. The same patients filled-in all the questionnaires. The patient reports were used to collect the data on medical history. A total of 303 patients were approached at Kuopio University Hospital in 2010-2011 and of these 196 patients were eligible and willing to participate, with postoperative data being available from 186 (95%) patients. A systematic review article was included in the study procedure and it revealed the wide range in the reported incidence of postoperative ocular pain. Some of the identified randomized controlled studies reported no or only minor pain whereas in some studies significant pain or pain lasting for several weeks has been described in more than 50% of the study patients. In the present study setting, pain was reported by 34% during the first postoperative hours and by approximately 10% of patients during the first six weeks after surgery. During the early recovery in the hospital, only a minority of the patients reporting pain were provided with pain medication. The ocular discomfort symptoms such as itchiness, burning, foreign-body sensation and tearing were common both before (54%) and after surgery (38-52%). These symptoms can also be described as painful symptoms and are often difficult to distinguish from ocular pain. The symptoms are also typical of ocular surface disease, and some patients may benefit from the postoperative administration of tear substitutes. The patients reporting postoperative ocular symptoms were less satisfied with the treatment outcome at 12 months after surgery (p = 0.001) compared to the patients who experienced no symptoms. Those patients reporting less disability in visual functioning before surgery were more satisfied than patients with more reported disability. The HRQoL improved significantly after cataract surgery (p = 0.002). However, when compared to an age-and gender-standardized control population, in cataract subjects the HRQoL remained slightly worse both before and at 12 months after surgery.
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Affiliation(s)
- Susanna Porela-Tiihonen
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Hannu Kokki
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Kai Kaarniranta
- Department of Ophthalmology; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
| | - Merja Kokki
- Department of Anaesthesiology and Department of Intensive Care Medicine; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
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Malik A, Sadafale A, Gupta YK, Gupta A. A comparative study of various topical nonsteroidal anti-inflammatory drugs to steroid drops for control of post cataract surgery inflammation. Oman J Ophthalmol 2016; 9:150-156. [PMID: 27843229 PMCID: PMC5084497 DOI: 10.4103/0974-620x.192268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postoperative inflammation continues to be a cause of patient discomfort, delayed recovery, and in some cases, suboptimal visual results. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid are commonly used in the management and prevention of noninfectious ocular inflammation following cataract surgery. AIMS The aim was to study the safety and efficacy of various NSAIDs drops for control of postoperative inflammation following cataract surgery and compare with steroid eye drops in a patient following cataract surgery. SUBJECTS AND METHODS Totally, 200 patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly assigned to receive either nepafenac 0.1% 3 times daily, bromfenac 0.09% twice daily, ketorolac 0.5% 4 times daily for 1 month or 1% prednisolone eye drops as their postoperative anti-inflammatory medication with 50 cases in each group. The patients were examined at the 1st day (baseline), 1st week, 2nd week, and 4th week after surgery. Postoperative inflammation was evaluated subjectively by intraocular pressure, slit-lamp assessment of signs of inflammation, including conjunctival hyperemia, ocular pain, and aqueous cells and flare. STATISTICAL ANALYSIS Statistical analysis was performed by the SPSS program for Windows, version 17.0. RESULTS AND CONCLUSIONS In our study, we found that prednisolone 1% was more effective in controlling postoperative intraocular inflammation in terms of reducing anterior chamber cells and flare. We found that ketorolac 0.5% and nepafenac 0.1% were equally effective in controlling postoperative ocular pain and inflammation. All four drugs are effective in controlling post cataract surgery ocular inflammation. Intraocular inflammation is best controlled with prednisolone 1%, while ocular pain and hyperemia are better controlled with NSAIDs in the early postoperative periods.
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Affiliation(s)
- Anu Malik
- Department of Ophthalmology, Ndmc Medical College and Hindu Rao Hospital, Delhi, India
| | - Anup Sadafale
- Department of Ophthalmology, Ndmc Medical College and Hindu Rao Hospital, Delhi, India
| | - Yogesh Kumar Gupta
- Department of Ophthalmology, Ndmc Medical College and Hindu Rao Hospital, Delhi, India
| | - Alka Gupta
- Department Of Ophthalmology, Llrm Medical College, Meerut, Uttar Pradesh, India
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Gonzalez-Salinas R, Guarnieri A, Guirao Navarro MC, Saenz-de-Viteri M. Patient considerations in cataract surgery - the role of combined therapy using phenylephrine and ketorolac. Patient Prefer Adherence 2016; 10:1795-1801. [PMID: 27695298 PMCID: PMC5029911 DOI: 10.2147/ppa.s90468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cataract, a degradation of the optical quality of the crystalline lens, progressive and age-related, is the leading cause of treatable blindness worldwide. Cataract surgery is the most common surgical procedure performed by ophthalmologists and is the only effective treatment for cataracts. Advances in the surgical techniques and better postoperative visual outcomes have progressively changed the primary concern of cataract surgery to become a procedure refined to yield the best possible refractive results. Sufficient mydriasis during cataract removal is critical to a successful surgical outcome. Poor pupil dilation can lead to serious sight-threatening complications that significantly increase the cost of surgery and decrease patients comfort. Mydriasis is obtained using anticholinergic and sympathomimetic drugs. Phenylephrine, an α1-adrenergic receptor agonist, can efficiently dilate the pupil when administered by intracameral injection. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, which inhibit the synthesis of prostaglandins, are used to decrease intraoperative miosis, control pain and inflammation associated with cataract surgery, and to prevent the development of cystoid macular edema following surgery. Recently, a new combination of phenylephrine and ketorolac (Omidria®) has been approved by United States Food and Drug Administration for use during cataract surgery to maintain intraoperative mydriasis, prevent miosis, and reduce postoperative pain and inflammation. Clinical trials have shown that this new combination is effective, combining the positive effects of both drugs with a good safety profile and patient tolerability. Moreover, recent reports suggest that this combination is also effective in patients with high risk of poor pupil dilation. In conclusion, cataract is a global problem that significantly affects patients' quality of life. However, they can be managed with a safe and minimally invasive surgery. Advances in surgical techniques and newer pharmacological agents such as the combination of phenylephrine and ketorolac, together with better intraocular lenses, have greatly improved visual outcomes and thus patients' expectations regarding visual recovery are also increasing.
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Affiliation(s)
- Roberto Gonzalez-Salinas
- Department of Biomedical Research, Universidad Autónoma de Querétaro, Querétaro, Mexico
- Department of Research, Asociación para Evitar la Ceguera en México, Mexico City, Mexico
| | - Adriano Guarnieri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Manuel Saenz-de-Viteri
- Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain
- Correspondence: Manuel Saenz-de-Viteri, Ave Pio XII 36, 31008 Pamplona, Navarra, Spain, Tel +34 948 948 25 54 00, Fax +34 948 296 500, Email
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Sahu S, Ram J, Bansal R, Pandav SS, Gupta A. Effect of topical ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09% on postoperative inflammation using laser flare photometry in patients having phacoemulsification. J Cataract Refract Surg 2015; 41:2043-8. [DOI: 10.1016/j.jcrs.2015.10.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/22/2022]
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Wilson DJ, Schutte SM, Abel SR. Comparing the Efficacy of Ophthalmic NSAIDs in Common Indications. Ann Pharmacother 2015; 49:727-34. [PMID: 25725037 DOI: 10.1177/1060028015574593] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To review the commercially available ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs), identify opportunities for therapeutic substitutions within and outside of their Food and Drug Administration (FDA)-approved indications, and identify clinically superior drugs within the class for specific indications. Data Source: A PubMed search (1992 through January 2014) was performed on the terms diclofenac, ketorolac, flurbiprofen, bromfenac, and nepafenac. Study Selection and Data Extraction: Clinical trials, meta-analyses, and review articles were evaluated if they were written in English and pertained to human subjects. Studies were excluded if they were in vitro studies, solely evaluated pharmacokinetic or pharmacodynamic properties, did not relate to the topical ophthalmic route, did not evaluate the FDA-approved indications of any available ophthalmic NSAID, or compared a reviewed drug with a nonreviewed drug (without placebo comparison). Data Synthesis: A total of 67 articles met the criteria for evaluation. Article quality, study design, and dosing of the medications were assessed to determine the clinical applicability of the results. The quality of the article was determined using the Oxford Centre for Evidence-based Medicine Levels of Evidence 1. Conclusions: Many formulations of the 5 reviewed NSAIDs have been studied across the 4 primary indications. These indications are (1) pain and inflammation associated with cataract surgery, (2) pain associated with corneal refractive surgery, (3) inhibition of intraoperative miosis, and (4) seasonal allergic conjunctivitis. Several studies have directly compared drugs within this class and have identified instances in which certain selections are therapeutically superior or equivalent to another. This information provides practitioners with guidance in selecting an optimal medication.
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Affiliation(s)
| | | | - Steven R. Abel
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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Liu C, Liu Y, Ye S, Liu L, Zhang W, Wu M. Effect of Topical Nonsteroidal Anti-Inflammatory Drugs and Nuclear Hardness on Maintenance of Mydriasis During Phacoemulsification Surgery. J Ocul Pharmacol Ther 2014; 30:831-6. [DOI: 10.1089/jop.2013.0244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuhua Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shaobi Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Liangping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wanjun Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Mingxing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Duong HVQ, Westfield KC, Singleton IC. Treatment Paradigm After Uncomplicated Cataract Surgery: A Prospective Evaluation. Asia Pac J Ophthalmol (Phila) 2014; 3:220-5. [PMID: 26107761 DOI: 10.1097/apo.0000000000000014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare 3 clinical variables, namely, visual recovery, anterior chamber inflammation, and macular edema, between 2 different regimens after uncomplicated cataract surgery. DESIGN Prospective, randomized, single-blind study at a single center, private, teaching practice in Las Vegas, NV. METHODS Patients randomized to group I (nonsteroidal anti-inflammatory drugs, n = 113) received besifloxacin ophthalmic suspension 0.6% and bromfenac 0.09%, whereas those randomized to group II (steroid, n = 109) received besifloxacin ophthalmic suspension 0.6% and prednisolone acetate 1%.Preoperative evaluation included a baseline macular optical coherence tomography. Postoperative data collected included visual acuity, direct visual anterior segment cell and flare counts, and macular optical coherence tomographies. Foveal thickness and total macular volume were used to assess the presence of cystoid macular edema. RESULTS Visual recovery was statistically insignificant with P values at 0.7, 0.10, 0.2, and 0.7 at 1 day, 1 week, 1 month, and 2 months, respectively.The degree of anterior segment inflammation was not statistically significant (P = 0.8) between the studied populations.The foveal thickness (1 week, P = 0.8; 1 month, P = 0.2; 2 months, P = 0.2) and total macular volume (1 week, P = 0.7; 1 month, P = 0.1; 2 months, P = 0.2) were not statistically significant between the groups, and the observed power were 0.902 and 0.666, respectively. CONCLUSIONS This study demonstrated that bromfenac was equally efficacious when compared with a potent topical steroid in restoring visual function, decreasing and resolving anterior chamber inflammation, and preventing the development of macular edema.
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Affiliation(s)
- Hon-Vu Q Duong
- From the *Westfield Eye Center, Las Vegas; and †Nevada State College, Henderson, NV
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Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology 2014; 121:1915-24. [PMID: 24935281 DOI: 10.1016/j.ophtha.2014.04.035] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/01/2014] [Accepted: 04/23/2014] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Favorable outcome after cataract surgery depends on proper control of the inflammatory response induced by cataract surgery. Pseudophakic cystoid macular edema is an important cause of visual decline after uncomplicated cataract surgery. DESIGN We compared the efficacy of topical steroids with topical nonsteroidal anti-inflammatory drugs (NSAIDs) in controlling inflammation and preventing pseudophakic cystoid macular edema (PCME) after uncomplicated cataract surgery. PARTICIPANTS Patients undergoing uncomplicated surgery for age-related cataract. METHODS We performed a systematic literature search in Medline, CINAHL, Cochrane, and EMBASE databases to identify randomized trials published from 1996 onward comparing topical steroids with topical NSAIDs in controlling inflammation and preventing PCME in patients undergoing phacoemulsification with posterior chamber intraocular lens implantation for age-related cataract. MAIN OUTCOME MEASURES Postoperative inflammation and pseudophakic cystoid macular edema. RESULTS Fifteen randomized trials were identified. Postoperative inflammation was less in patients randomized to NSAIDs. The prevalence of PCME was significantly higher in the steroid group than in the NSAID group: 3.8% versus 25.3% of patients, risk ratio 5.35 (95% confidence interval, 2.94-9.76). There was no statistically significant difference in the number of adverse events in the 2 treatment groups. CONCLUSIONS We found low to moderate quality of evidence that topical NSAIDs are more effective in controlling postoperative inflammation after cataract surgery. We found high-quality evidence that topical NSAIDs are more effective than topical steroids in preventing PCME. The use of topical NSAIDs was not associated with an increased events. We recommend using topical NSAIDs to prevent inflammation and PCME after routine cataract surgery.
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Kida T, Kozai S, Takahashi H, Isaka M, Tokushige H, Sakamoto T. Pharmacokinetics and efficacy of topically applied nonsteroidal anti-inflammatory drugs in retinochoroidal tissues in rabbits. PLoS One 2014; 9:e96481. [PMID: 24796327 PMCID: PMC4010472 DOI: 10.1371/journal.pone.0096481] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/09/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the pharmacokinetics and efficacy of topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) in the retinochoroidal tissues of rabbits. Methods The cyclooxygenase (COX) inhibitory activity of diclofenac, bromfenac, and amfenac, an active metabolite of nepafenac, were determined using human-derived COX-1 and COX-2. Each of the three NSAIDs was applied topically to rabbits, and after 0.5 to 8 hrs, the concentration of each drug in the aqueous humor and the retinochoroidal tissues was measured by liquid chromatography-tandem mass spectrometry. The pharmacokinetics of the drugs in the tissues after repeated doses as is done on patients was calculated by a simulation software. The inhibitory effect of each NSAID on the breakdown of the blood-retinal barrier was assessed by the vitreous protein concentration on concanavalin A-induced retinochoroidal inflammation in rabbits. Results The half-maximal inhibitory concentration (IC50) of diclofenac, bromfenac, and amfenac was 55.5, 5.56, and 15.3 nM for human COX-1, and 30.7, 7.45, and 20.4 nM for human COX-2, respectively. The three NSAIDs were detected in the aqueous humor and the retinochoroidal tissue at all-time points. Simulated pharmacokinetics showed that the levels of the three NSAIDs were continuously higher than the IC50 of COX-2, as an index of efficacy, in the aqueous humor, whereas only the bromfenac concentration was continuously higher than the IC50 at its trough level in the retinochoroidal tissues. The intravitreous concentration of proteins was significantly reduced in rabbits that received topical bromfenac (P = 0.026) but not the other two NSAIDs. Conclusions Topical bromfenac can penetrate into the retinochoroidal tissues in high enough concentrations to inhibit COX-2 and exerts its inhibitory effect on the blood-retinal barrier breakdown in an experimental retinochoroidal inflammation in rabbits. Topical bromfenac may have a better therapeutic benefit than diclofenac and nepafenac for retinochoroidal inflammatory diseases.
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Affiliation(s)
- Tetsuo Kida
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiko Kozai
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Hiroaki Takahashi
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Mitsuyoshi Isaka
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Hideki Tokushige
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- * E-mail:
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23
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Bottós JM, Farah ME, Höfling-Lima AL, Aggio FB. Pharmacology, clinical efficacy and safety of nepafenac ophthalmic suspension. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.2.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Postoperative pain after cataract surgery. J Cataract Refract Surg 2013; 39:789-98. [PMID: 23608571 DOI: 10.1016/j.jcrs.2013.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/02/2012] [Accepted: 09/22/2012] [Indexed: 11/23/2022]
Abstract
Cataract extraction surgery is the most common surgical procedure, but knowledge of postoperative pain related to cataract surgery is sparse. In this systematic review, the incidence, prevalence, and management of pain after phacoemulsification surgery were identified using PubMed and Scopus. Selected studies were restricted to randomized controlled trials with interventions on postoperative inflammation and pain. Data from 105 articles were extracted and 21 studies met the final inclusion criteria. Most studies reported no or only mild postoperative pain, but some reported moderate and severe pain and pain lasting several weeks. The interventions consisted of drug therapy including topical nonsteroidal antiinflammatory drugs, corticosteroids, paracetamol, perioperative intraocular injections, eye pads used after surgery, and various surgical techniques. The reviewed literature indicates that cataract surgery is associated with significant postoperative pain in some patients, who should be provided with appropriate counseling and pain treatment.
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25
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Topical nonsteroidal anti-inflammatory drugs for macular edema. Mediators Inflamm 2013; 2013:476525. [PMID: 24227908 PMCID: PMC3818914 DOI: 10.1155/2013/476525] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/29/2013] [Indexed: 01/03/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are nowadays widely used in ophthalmology to reduce eye inflammation, pain, and cystoid macular edema associated with cataract surgery. Recently, new topical NSAIDs have been approved for topical ophthalmic use, allowing for greater drug penetration into the vitreous. Hence, new therapeutic effects can be achieved, such as reduction of exudation secondary to age-related macular degeneration or diabetic maculopathy. We provide an updated review on the clinical use of NSAIDs for retinal diseases, with a focus on the potential future applications.
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26
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Jones BM, Neville MW. Nepafenac: An Ophthalmic Nonsteroidal Antiinflammatory Drug for Pain After Cataract Surgery. Ann Pharmacother 2013; 47:892-6. [DOI: 10.1345/aph.1r757] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To examine the efficacy of nepafenac in the treatment of pain and inflammation in patients after cataract surgery using evidence from controlled clinical studies. DATA SOURCES: Citations in Google Scholar, PubMed, and Web of Science from January 1, 2005, to March 25, 2013, were identified using nepafenac and cataract as search terms. STUDY SELECTION AND DATA EXTRACTION: The literature search was limited to human studies published in English. Three trials that compared nepafenac with other nonsteroidal antiinflammatory drugs (NSAIDs) were included. DATA SYNTHESIS: The pharmacokinetics and pharmacodynamics of nepafenac 0.1% suspension (and its active metabolite, amfenac) were compared with bromfenac 0.09% solution and ketorolac 0.4% solution with respect to aqueous humor concentrations and ability to reduce cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes. The maximum concentration (Cmax) values of ketorolac and amfenac were statistically similar, while the Cmax of bromfenac was significantly lower than that of amfenac. Ketorolac most effectively inhibited COX-1 enzymes; COX-2 enzymes were most effectively reduced by amfenac. When nepafenac 0.1% suspension was compared with placebo and ketorolac 0.5% solution, nepafenac achieved a higher percentage cure rate than placebo at day 14 (p = 0.0241). Significant differences in cure rates between nepafenac and ketorolac were not observed. Nepafenac 0.1%, bromfenac 0.09%, and ketorolac 0.45% were compared to determine which most effectively reduced prostaglandin E2 (PGE2) following surgery. PGE2 concentrations were significantly lowest in the ketorolac group, followed by the bromfenac and nepafenac groups, respectively. Topical nepafenac 0.1% suspension was approved in 2005. A 0.3% suspension was approved in October 2012. The 0.3% product may have some advantages over its predecessor: it is dosed once rather than thrice daily, which may increase patient adherence and improve outcomes. The price and dosing frequency of the 0.3% product are comparable to those of bromfenac 0.09% solution. CONCLUSIONS: The 2 nepafenac products appear to be equally efficacious, with a slightly increased adverse event rate in patients using the 0.3% versus 0.1% formulation. Head-to-head clinical trials that compare the 0.3% product with the 0.1% product or other commercially available NSAIDs are unavailable.
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Affiliation(s)
- Benjamin M Jones
- Benjamin M Jones, PharmD student, College of Pharmacy, University of Georgia, Athens
| | - Michael W Neville
- Michael W Neville PharmD BCPS FASHP, Clinical Associate Professor, College of Pharmacy, University of Georgia
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Abstract
Ketorolac 0.45% ophthalmic solution is a topical NSAID indicated in the US for the treatment of ocular pain and inflammation following cataract surgery. In animal studies, the ocular relative bioavailability of single-dose topical ketorolac 0.45% ophthalmic solution was 2- to 3-fold higher than that of ketorolac 0.4% ophthalmic solution. In two identically designed, randomized, double-masked, multicentre trials in adult patients undergoing cataract extraction, the proportions of patients with a summed ocular inflammation score of zero for anterior chamber cell count plus anterior chamber flare on day 14 after surgery were significantly greater in those treated with topical ketorolac 0.45% ophthalmic solution than in those treated with vehicle placebo. Compared with placebo, topical ketorolac 0.45% ophthalmic solution significantly increased the proportion of patients who were pain-free on the day after surgery in both trials. Ketorolac 0.45% ophthalmic solution was generally well tolerated in clinical trials with lower overall incidences of treatment-emergent and treatment-related adverse events than placebo, and with no single treatment-related adverse event having a higher incidence than with placebo.
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Maldonado RM, Vianna RNG, Cardoso GP, de Magalhães AV, Burnier MN. Intravitreal injection of commercially available ketorolac tromethamine in eyes with diabetic macular edema refractory to laser photocoagulation. Curr Eye Res 2011; 36:768-73. [PMID: 21780926 DOI: 10.3109/02713683.2011.585734] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the short-term effect of a single intravitreal injection of commercially available ketorolac tromethamine (KT) in eyes with diabetic macular edema refractory to laser photocoagulation. METHODS Prospective interventional case series. Twenty five patients with diabetic macular edema refractory to laser photocoagulation received a single intravitreal injection of commercially available KT (Toradol®), in a dose of 3000 µg. Examination included assessment of ETDRS-best corrected visual acuity (BCVA), measurement of intraocular pressure and high resolution imaging by optical coherence tomography, preoperatively and 7, 15, and 30 days postoperatively. RESULTS In the follow up visits at 7, 15 and 30 days, BCVA had improved five or more letters in 20% (95% confidence interval, 7.7-38.9%), 16% (95% confidence interval, 5.3-34.2%) and 28% (95% confidence interval, 13.2-47.7%) respectively. An improvement in macular thickness was also observed, although it has not been statistically significant. CONCLUSION This pilot study showed that a single intravitreal injection of 3000 µg of commercial KT led to a short-term improvement of visual acuity in approximately 30% of eyes with diabetic macular edema refractory to laser photocoagulation.
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Affiliation(s)
- Renata Malvezzi Maldonado
- Retina & Vitreous Unit, Department of Ophthalmology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Reddy R, Kim SJ. Critical appraisal of ophthalmic ketorolac in treatment of pain and inflammation following cataract surgery. Clin Ophthalmol 2011; 5:751-8. [PMID: 21750608 PMCID: PMC3130912 DOI: 10.2147/opth.s7633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this review was to provide a critical appraisal of the literature supporting the efficacy of ophthalmic ketorolac (Acuvail®) in the treatment of pain and inflammation after cataract surgery. Methods: Literature search and expert opinion of the authors. Results: Recent studies indicate greater intraocular drug levels in the anterior chamber and iris-ciliary body after topical application of Acuvail in comparison with older formulations of ketorolac. A large randomized, multicenter, placebo-controlled study demonstrated significantly less inflammation and pain after cataract surgery using Acuvail. Conclusion: Acuvail appears to be effective in reducing post-cataract surgery pain and inflammation.
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Affiliation(s)
- Rahul Reddy
- Department of Ophthalmology, Vanderbilt University, Nashville, TN, USA
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Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol 2010; 55:108-33. [PMID: 20159228 DOI: 10.1016/j.survophthal.2009.07.005] [Citation(s) in RCA: 240] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/20/2009] [Accepted: 07/28/2009] [Indexed: 02/02/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are increasingly employed in ophthalmology to reduce miosis and inflammation, manage scleritis, and prevent and treat cystoid macular edema associated with cataract surgery. In addition, they may decrease postoperative pain and photophobia associated with refractive surgery and may reduce the itching associated with allergic conjunctivitis. In recent years, the U.S. Food and Drug Administration has approved new topical NSAIDs, and previously approved NSAIDs have been reformulated. These additions and changes result in different pharmacokinetics and dosing intervals, which may offer therapeutic advantages. For example, therapeutic effects on diabetic retinopathy and age-related macular degeneration may now be achievable. We provide an updated review on NSAIDs and a summary of their current uses in ophthalmology with attention to potential future applications.
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Affiliation(s)
- Stephen J Kim
- Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee 37232, USA.
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31
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Sandoval HP, Solomon KD. Ketorolac tromethamine 0.4% to relieve eye pain and inflammation following cataract extraction and keratorefractive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2009. [DOI: 10.1586/eop.09.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Ketorolac versus nepafenac in cataract surgery. J Cataract Refract Surg 2008; 34:345-6; author reply 346. [DOI: 10.1016/j.jcrs.2007.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 11/16/2007] [Indexed: 11/19/2022]
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