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Thompson V, Moshirfar M, Clinch T, Scoper S, Linn SH, McIntosh A, Li Y, Eaton M, Ferriere M, Stasi K. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) for Postoperative Pain After Photorefractive Keratectomy. Transl Vis Sci Technol 2023; 12:7. [PMID: 36917119 PMCID: PMC10020951 DOI: 10.1167/tvst.12.3.7] [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: 03/16/2023] Open
Abstract
Purpose Evaluation of safety and efficacy of topical ocular SAF312 (Libvatrep) in post-photorefractive keratectomy (PRK) pain. Methods In this placebo (vehicle)-controlled, participant- and investigator-masked study, 40 participants were randomized (1:1) to two treatment sequences in a bilateral PRK crossover design (SAF312 2.5% followed by vehicle [or vice versa], one eye drop, four times daily for 72 hours after PRK). Primary endpoints were visual analog scale (VAS) pain scores at 6 hours after first drop of study drug and average VAS scores over 0 to 12 hours postoperatively. Secondary endpoints included postoperative oral rescue medication (ORM) use and adverse events (AEs). Results All 40 participants completed the study. Both primary endpoints were met; mean difference in VAS pain scores between SAF312- and vehicle-treated eyes was -11.13 (P = 0.005, -25%) at 6 hours postoperatively and -8.56 (P = 0.017, -22%) over 0 to 12 hours. Mean VAS pain scores with SAF312 were consistently lower than with vehicle from 1 hour postoperatively up to 30 hours (P ≤ 0.10 observed in 8/11 time points). Less ORM was taken with SAF312 up to 0 to 72 hours postoperatively, with a trend of fewer participants taking ORM at 0 to 24 hours postoperatively with SAF312 versus vehicle. No serious AEs were reported. All ocular AEs were mild and transient, and none were drug related. SAF312-treated eyes showed no delay in wound healing and had a lower grade 4 conjunctival hyperemia 24 hours postoperatively versus vehicle-treated eyes. Conclusions SAF312 was well tolerated and effective in reducing ocular pain post-PRK. Translational Relevance Topical SAF312 presents a new therapeutic option for patients undergoing PRK.
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Affiliation(s)
- Vance Thompson
- Vance Thompson Vision, Sioux Falls, SD, USA.,University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Majid Moshirfar
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | | | - Steven H Linn
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | - Yifang Li
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Matt Eaton
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
| | | | - Kalliopi Stasi
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
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Hodge C, Chan C, Bali SJ, Sutton G. A review of corneal melting following kerato‐refractive surgery. Clin Exp Optom 2021; 96:14-9. [DOI: 10.1111/j.1444-0938.2012.00759.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christopher Hodge
- Vision Eye Institute, Chatswood, NSW, Australia,
- Sydney Medical School, The University of Sydney, Australia,
| | - Colin Chan
- Vision Eye Institute, Chatswood, NSW, Australia,
- Central Clinical School, The University of Sydney, Australia,
- School of Optometry and Vision Sciences, The University of New South Wales, Australia,
| | | | - Gerard Sutton
- Vision Eye Institute, Chatswood, NSW, Australia,
- Sydney Medical School, The University of Sydney, Australia,
- Central Clinical School, The University of Sydney, Australia,
- Sydney Medical School Foundation, Save Sight Institute, Sydney, NSW, Australia,
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Nanavaty M, Ashena Z, Bardan A, Thaker R, Bascaran L. Prophylactic use of nonsteroidal anti-inflammatory drugs after cataract surgery and corneal melt. J Curr Ophthalmol 2021; 33:485-491. [PMID: 35128199 PMCID: PMC8772489 DOI: 10.4103/joco.joco_107_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review. Methods: This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review. Results: This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health. Conclusion: Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.
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Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol 2020; 65:1-11. [DOI: 10.1016/j.survophthal.2019.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
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Abstract
Phototherapeutic keratectomy is an excimer laser-based surgical procedure widely performed by corneal surgeons for treating anterior corneal stromal pathologies. Phototherapeutic keratectomy helps by ablating the corneal stroma, thereby improving corneal clarity and smoothening the surface. Transient discomfort and induced hyperopia from corneal flattening are the immediate postoperative concerns. The long-term course is often marked by the recurrence of original corneal pathology and corneal haze formation. Phototherapeutic keratectomy, however, allows for repeat stromal ablation for managing recurrences, as the corneal thickness permits, without affecting the outcome of future keratoplasty. Adjunctive methods such as topical mitomycin-C may be additionally used to reduce recurrence rates. Also, various masking agents such as carboxymethyl cellulose, sodium hyaluronate, and dextran are used in eyes with irregular corneal surface to allow for uniform stromal ablation. Overall, phototherapeutic keratectomy has provided corneal surgeons an additional surgical tool, particularly those residing in developing nations where the availability of donor corneal tissue is an important limiting factor.
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Comparison Between Diclofenac and Ketorolac Ophthalmic Drops for Pain Management After Photorefractive Keratectomy: A Randomized Clinical Study. Eye Contact Lens 2019; 45:137-140. [DOI: 10.1097/icl.0000000000000524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dua HS, Said DG, Messmer EM, Rolando M, Benitez-del-Castillo JM, Hossain PN, Shortt AJ, Geerling G, Nubile M, Figueiredo FC, Rauz S, Mastropasqua L, Rama P, Baudouin C. Neurotrophic keratopathy. Prog Retin Eye Res 2018; 66:107-131. [DOI: 10.1016/j.preteyeres.2018.04.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
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Kontadakis GA, Chronopoulou KG, Tsopouridou R, Tabibian D, Kymionis GD. Nepafenac Ophthalmic Suspension 0.3% for the Management of Ocular Pain After Photorefractive Keratectomy. J Refract Surg 2018. [PMID: 29522226 DOI: 10.3928/1081597x-20180123-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effect of nepafenac 0.3% in a once daily dosage regarding pain and healing after photorefractive keratectomy (PRK). METHODS This was a prospective, comparative, contralateral randomized study of 35 patients undergoing PRK for the correction of low to moderate myopia and myopic astigmatism. After randomization, patients received nepafenac 0.3% ophthalmic suspension once daily in one eye (nepafenac 0.3% group) and nepafenac 0.1% ophthalmic suspension three times a day in the other eye (nepafenac 0.1% group) until the second postoperative day. Pain was evaluated every 2 hours on the day of the operation and then once daily using a scale ranging from 0 to 4. Patients were then examined at 2 weeks and 1, 3, 6, and 12 postoperative months. Visual acuity and subepithelial haze were also assessed. RESULTS No differences were detected between groups in pain scores, subepithelial haze scores, or visual acuity. Refractive predictability was also similar. CONCLUSIONS Nepafenac 0.3% ophthalmic suspension in a daily regimen after PRK seems to be an effective treatment for pain and ocular discomfort with effects similar to the 0.1% suspension. [J Refract Surg. 2018;34(3):171-176.].
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Farooq AV, Gibbons AG, Council MD, Harocopos GJ, Holland S, Judelson J, Shoss BL, Schmidt EJ, Md Noh UK, D'Angelo A, Chundury RV, Judelson R, Perez VL, Huang AJ. Corneal Toxicity Associated With Aquarium Coral Palytoxin. Am J Ophthalmol 2017; 174:119-125. [PMID: 27793603 DOI: 10.1016/j.ajo.2016.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin. DESIGN Multicenter retrospective case series. METHODS Retrospective review. RESULTS Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested. CONCLUSIONS This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.
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Choi EY, Kang HG, Kim TI, Kim EK, Lee HK. Effect of postoperative administration of nonsteroidal antiinflammatory drugs and steroids on the conformational changes in wound healing after cataract surgery. J Cataract Refract Surg 2016; 42:1804-1813. [DOI: 10.1016/j.jcrs.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/22/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
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Cystoid macular edema associated with iridocorneal endothelial syndrome: a case report. BMC Ophthalmol 2016; 16:155. [PMID: 27585567 PMCID: PMC5008000 DOI: 10.1186/s12886-016-0333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iridocorneal endothelial (ICE) syndrome occurs mainly in young and middle-aged women and typically presents as a unilateral disease characterized by abnormalities of the iris and corneal endothelium. While the ICE syndrome is known to be associated with glaucoma and bullous keratopathy, to our knowledge, only two cases of ICE syndrome complicated with cystoid macular edema (CME) have been reported to date. In this paper, we report a case of ICE syndrome complicated with CME treated at our institution. CASE PRESENTATION The subject was a 51-year-old woman. In October 2013, she was examined by a primary care physician for blurred vision in her left eye. Dyscoria and abnormality of the corneal endothelium were observed, and the patient was diagnosed with ICE syndrome. In November of the same year, she was referred to our institution with a decrease in visual acuity and CME, both in her left eye. At initial examination, her best corrected decimal visual acuity was 1.0 (Snellen equivalent: 20/20) in the right eye and 0.5 (20/40) in the left eye. Intraocular pressure was 12 mmHg in both eyes. She was diagnosed with Cogan-Reese syndrome based on marked ectropion uveae, peripheral anterior synechia, and abnormalities of the corneal endothelium. Marked CME was observed on ophthalmoscopy and optical coherence tomography. A topical non-steroidal anti-inflammatory drug (nepafenac 0.1 %) was applied to the left eye four times daily from January 2014. Four weeks later, the CME had resolved and her visual acuity was 1.0 (20/20). CONCLUSION While non-steroidal anti-inflammatory drugs and steroids did not appear to be effective in two previously reported cases of ICE syndrome complicated with CME, topical nepafenac was effective in this case. However, more such cases are needed before concluding that topical nepafenac is effective in this situation.
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Yüksel B, Uzunel UD, Kerci SG, Sağban L, Küsbeci T, Örsel T. Comparison of Subtenon Triamcinolone Acetonide Injection with Topical Nepafenac for the Treatment of Pseudophakic Cystoid Macular Edema. Ocul Immunol Inflamm 2016; 25:513-519. [PMID: 27015572 DOI: 10.3109/09273948.2016.1147587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the efficacy and safety of subtenon triamcinolone acetonide (TA) injection with topical nepafenac 0.1% for the treatment of pseudophakic cystoid macular edema (CME). METHODS In this prospective study, the TA group comprised 24 eyes and the nepafenac group 24 eyes. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure measurements, and slit-lamp fundoscopy were performed in all subjects at baseline, 1, 2, 3, and 6 months. RESULTS Changes in BCVA and CRT over four follow-up visits were statistically significant (p<0.001). The mean CRT decreased from 513.3 to 318.9 μm in the TA group and from 483.7 to 278.0 μm in the nepafenac group. This reduction was statistically significant (p<0.001 for both groups). CONCLUSIONS Our visual and OCT results suggest that both treatment modalities are effective with few side-effects. However, nepafenac is more efficacious than subtenon TA in terms of visual gain and its correlation with the reduction in CRT.
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Affiliation(s)
- Bora Yüksel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Umut Duygu Uzunel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Süleyman Gökhan Kerci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Levent Sağban
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tuncay Küsbeci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tümay Örsel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
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Mohamed-Noriega K, Butrón-Valdez K, Vazquez-Galvan J, Mohamed-Noriega J, Cavazos-Adame H, Mohamed-Hamsho J. Corneal Melting after Collagen Cross-Linking for Keratoconus in a Thin Cornea of a Diabetic Patient Treated with Topical Nepafenac: A Case Report with a Literature Review. Case Rep Ophthalmol 2016; 7:119-24. [PMID: 27293413 PMCID: PMC4899655 DOI: 10.1159/000444437] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report the case of a 50-year-old woman with diabetes that presented with corneal melting and perforation 6 weeks after collagen cross-linking (CxL) for keratoconus (KC) and postoperative use of nepafenac eye drops, a nonsteroidal anti-inflammatory drug (NSAID). METHODS This is a case report of a patient with diabetes, KC and a thin cornea that had undergone left eye corneal CxL at a different hospital followed by postoperative use of nepafenac eye drops for 6 weeks. RESULTS The patient presented for the first time to our clinic with left corneal melting, perforation and iris prolapse 6 weeks after corneal CxL and topical nepafenac use. She was treated with a left eye tectonic penetrating keratoplasty, extracapsular cataract extraction, intraocular lens implantation and pupilloplasty. CONCLUSIONS The corneal melting and perforation in this patient was associated with multiple risk factors: (1) nepafenac eye drop use, (2) CxL in a cornea thinner than 400 µm and (3) diabetes. The recommended corneal thickness limits should be respected. Topical NSAIDs should be used with caution if used as postoperative treatment after corneal CxL and in patients with diabetes, epithelial defect or delayed healing, because of the possible increased risk for corneal melting when multiple risk factors are observed.
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Affiliation(s)
- Karim Mohamed-Noriega
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Karla Butrón-Valdez
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Jeronimo Vazquez-Galvan
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Jibran Mohamed-Noriega
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Humberto Cavazos-Adame
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Jesús Mohamed-Hamsho
- Department of Ophthalmology, Faculty of Medicine, University Hospital 'Dr. Jose Eleuterio Gonzalez', Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
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Kiss HJ, Takacs AI, Kranitz K, Sandor GL, Toth G, Gilanyi B, Nagy ZZ. One-Day Use of Preoperative Topical Nonsteroidal Anti-Inflammatory Drug Prevents Intraoperative Prostaglandin Level Elevation During Femtosecond Laser-Assisted Cataract Surgery. Curr Eye Res 2015; 41:1064-1067. [PMID: 26681407 DOI: 10.3109/02713683.2015.1092556] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if pretreatment with topical nonsteroidal anti-inflammatory drug (NSAID) prior to femtosecond laser-assisted cataract surgery (FLACS) prevents intraoperative prostaglandin level elevation as a potential risk factor of postoperative complications. PATIENTS AND METHODS Thirty-six patients with clinically significant cataract and without any concomitant general or ophthalmic disease were enrolled into the three age-matched groups of the study. The mean age of the patients was 62.3 ± 13.1 years. The first group of patients underwent traditional phacoemulsification (Control group), on the second group of patients FLACS was performed, and the third group of patients received topical 0.1% nepafenac pretreatment for 1one day prior to FLACS. Before the phacoemulsification part of the cataract surgery, approximately 110 µL of aqueous humor was collected in all groups. Total prostaglandin concentrations of the collected aqueous humor samples were evaluated by enzyme immunoassay (EIA). RESULTS The mean of the total prostaglandin concentrations of the aqueous humor samples was 208.8 ± 140.5 pg/mL in patients in the control group, 1449.1 ± 1019.7 pg/mL in the FLACS group (p > 0.001), and 92.2 ± 51.7 pg/mL in the group pretreated with topical NSAID before the FLACS (p > 0.001 compared to FLACS; p > 0.01 compared to control), respectively. CONCLUSIONS FLACS surgery increases intracameral prostaglandin concentration. However, using preoperative 1-day-long nonsteroid anti-inflammatory drops prior to FLACS, this intraoperative increase diminishes. Our study raises the possibility that NSAID pretreatment may be routinely administered before FLACS cataract surgeries to achieve a further decrease in the potential complications of increased total prostaglandin concentration during FLACS surgeries.
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Affiliation(s)
- Huba J Kiss
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
| | - Agnes I Takacs
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
| | - Kinga Kranitz
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
| | - Gabor L Sandor
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
| | - Gabor Toth
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
| | - Beatrix Gilanyi
- b Department of Medical Chemistry , Semmelweis University , Budapest H-1094 , Hungary
| | - Zoltan Z Nagy
- a Department of Ophthalmology , Semmelweis University , Budapest H-1085 , Hungary
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Zhai MZ, Wu HH, Li JJ, Jiang LP, Gao ZS, Hu W, Liu Y, Wang YT. Topical bromfenac for post-cataract extraction: A systematic review and pooled analysis. EUR J INFLAMM 2015. [DOI: 10.1177/1721727x15601732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bromfenac, a promising ophthalmic non-steroidal anti-inflammatory drug, has been used once daily for postoperative ocular inflammation and pain with satisfying efficacy, however, no integrated conclusion on its safety in clinical settings has been drawn. The purpose of this pooled analysis is to investigate the safety and efficacy of once daily bromfenac for ocular inflammation and pain among patients after cataract extraction (CE). MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to September 2014. Randomized controlled trials (RCTs) that studied topical bromfenac after CE were analyzed. Included studies were systemically reviewed, and effects were summarized using odds ratio (OR) with suitable effect model. Four RCTs involving 2294 participants were included. Topical bromfenac significantly increased the proportion of cleared ocular inflammation (OR, 2.37; 95% confidence interval [CI], 1.83–3.07; P <0.00001), ocular pain free (OR, 5.14; 95% CI, 4.07–6.49; P <0.00001), and decreased risk of overall adverse events (OR, 0.47; 95% CI, 0.38–0.58; P <0.00001). Bromfenac has been shown to be a safe and effective treatment for postoperative pain and inflammation in subjects undergoing CE. This is evidenced by the lower incidence of adverse events and the low scores for ocular pain and inflammation across multiple RCTs. However, demographics, co-morbidities of study participants, and the amount of co-medication were not reported, these possible sources of heterogeneity should be examined in future clinical trials.
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Affiliation(s)
- M-Z Zhai
- Department of Emergency, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
- Department of Medical Psychology, Fourth Military Medical University, Xi’an, PR China
| | - H-H Wu
- Department of Emergency, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
- Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China
| | - J-J Li
- Department of Emergency, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - L-P Jiang
- Department of Ophthalmology, the Second People’s Hospital of Rongcheng, Rongcheng, PR China
| | - Z-S Gao
- Department of Ophthalmology, Second People’s Hospital of Shanxi Province, Xi’an, PR China
| | - W Hu
- Department of Emergency, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Y Liu
- Department of Outpatient, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
| | - Y-T Wang
- Department of Emergency, Xi’jing Hospital, Fourth Military Medical University, Xi’an, PR China
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Fujishima H, Fuseya M, Ogata M, Murat D. Efficacy of bromfenac sodium ophthalmic solution for treatment of dry eye disease. Asia Pac J Ophthalmol (Phila) 2015; 4:9-13. [PMID: 26068607 DOI: 10.1097/apo.0000000000000032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the efficacy of bromfenac sodium ophthalmic solution (BF) in patients with dry eye disease (DED) inadequately controlled by monotherapy with artificial tears (ATs). DESIGN An investigator-oriented trial with a single-arm, nonrandomized, open-label design. METHODS Twenty-six patients, who showed no symptomatic improvement of DED after 1 month of AT treatment, were enrolled. Bromfenac sodium ophthalmic solution was administered adjunctively with AT for 1 month. The BF treatment was then discontinued, and AT treatment alone was continued for 3 months. The signs and symptoms were evaluated at the beginning of BF treatment (Pre), at the end of the combined BF and AT treatment (BF1M), and at 1 and 3 months after discontinuation of BF treatment (Po1M and Po3M, respectively). RESULTS The dryness scores at BF1M were significantly improved compared with Pre (P < 0.001) and significantly superior to Po3M (P < 0.001). No significant changes in the Schirmer scores were observed throughout the treatment period. The tear film breakup time was significantly improved at BF1M (4.4 ± 2.3 seconds) compared with Pre (2.8 ± 1.8 seconds; P < 0.001). Superficial punctate keratopathy showed significant improvements in the total score of area and density at BF1M compared with Pre (P < 0.001). However, these parameters had significantly worsened at Po3M compared with BF1M. No adverse events were observed. CONCLUSIONS Bromfenac sodium ophthalmic solution has improved the dryness of the eye and signs of DED through its anti-inflammatory effects. Nonsteroidal anti-inflammatory drugs were suitable as anti-inflammatory ophthalmic solutions for patients with DED.
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Affiliation(s)
- Hiroshi Fujishima
- From the *Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa; and †Department of Ophthalmology, Tokyo Saiseikai Central Hospital; and ‡J&J Ocular Surface and Visual Optics Department, Keio University School of Medicine, Tokyo, Japan
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Comparison of analgesic effect of preoperative topical diclofenac and ketorolac on postoperative pain after photorefractive keratectomy. J Cataract Refract Surg 2014; 40:1689-96. [DOI: 10.1016/j.jcrs.2014.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/07/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022]
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Abstract
Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here.
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Affiliation(s)
- Varsha M Rathi
- Cornea, Anterior Segment and Refractive Surgery Services, L V Prasad Eye Institute, Hyderabad, AP, India.
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19
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Abstract
PRACTICAL RELEVANCE Corneal ulcers in cats (ulcerative keratitis) are a common presenting complaint, and are a frequent sequela to feline herpesvirus (FHV-1) infection. In fact, it is fair to assume an FHV-1 aetiology until proven otherwise. In practice, therefore, many cases of corneal ulceration can be treated medically, but treatment can frequently be challenging, with the need to tailor therapy carefully to the type of ulcer, the individual cat and its temperament. PATIENT GROUP All age groups and breeds can suffer with ulcerative keratitis although some breeds are over-represented for some types of corneal ulceration. EVIDENCE BASE The scientific literature on feline ulcerative keratitis is extensive, particularly that related to FHV-1 infection. This article reviews the medical treatment options for corneal ulceration in cats with reference to the current evidence base.
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Affiliation(s)
- Claudia Hartley
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK.
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