Effect of non-steroidal anti-inflammatory ophthalmic solution on intraocular pressure reduction by latanoprost in patients with primary open angle glaucoma or ocular hypertension

The Roles Played by FP/EP3 Receptors During Pressure-lowering in Mouse Eyes Mediated by a Dual FP/EP3 Receptor Agonist

Purpose

We investigated the intraocular pressure (IOP)-lowering effect of topical sepetaprost (SPT), a dual agonist of the FP and EP3 receptors. We explored whether certain receptors mediated the hypotensive effect of SPT and outflow facility changes in C57BL/6 mice (wild-type [WT]) and FP and EP3 receptor-deficient mice (FPKO and EP3KO mice, respectively).

Methods

IOP was measured using a microneedle. Outflow facility was measured using a two-level, constant-pressure perfusion method.

Results

SPT significantly reduced IOP for 8 hours after administration to WT mice. The 2-hour IOP reductions afforded by latanoprost were 15.3 ± 2.5, 1.8 ± 2.0, and 12.3 ± 2.4% in WT, FPKO, and EP3KO mice, respectively; the SPT figures were 13.6 ± 2.1, 5.9 ± 2.7, and 6.6 ± 2.6%, respectively. Latanoprost-mediated IOP reduction was significantly decreased in FPKO mice, and SPT-mediated IOP reduction was reduced in both FPKO and EP3KO mice. At 6 hours after administration, latanoprost did not significantly reduce the IOP in any tested mouse strain. SPT-mediated IOP reduction was reduced in both FPKO and EP3KO mice. IOP reduction at 6 hours was significantly higher after simultaneous administration of selective FP and EP3 receptor agonists, but IOP did not fall on administration of (only) a selective EP3 receptor agonist. SPT significantly increased outflow facility in WT mice, but less so in FPKO and EP3KO mice.

Conclusions

The IOP-lowering effect of SPT lasted longer than that of latanoprost. Our data imply that this may be attributable to augmented outflow facility mediated by the FP and EP3 receptors.

Nonsteroidal anti-inflammatory drugs for retinal neurodegenerative diseases

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common prescription drugs for inflammation, and topical NSAIDs are often used in ophthalmology to reduce pain, photophobia, inflammation, and edema. In recent years, many published reports have found that NSAIDs play an important role in the treatment of retinal neurodegenerative diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, pathological myopia, and retinitis pigmentosa (RP). The aim of the current review is to provide an overview of the role of various NSAIDs in the treatment of retinal neurodegenerative diseases and the corresponding mechanisms of action. This review highlighted that the topical application of NSAIDs for the treatment of retinal degenerative diseases has been studied to a remarkable extent and that its beneficial effects in many diseases have been proven. In the future, prospective studies with large study populations are required to extend these effects to clinical settings.

Efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation in cataract surgery: A protocol for systematic review and meta-analysis

BACKGROUND

A cataract is a degenerative change in the optical quality of the lens caused by protein denaturation. Modern medicine is mainly based on surgical treatment. Cataract surgery is often accompanied by severe inflammation, and glucocorticoid therapy has many adverse reactions and side effects. The non-steroidal anti-inflammatory drug sodium bromfenac not only has good anti-inflammatory, analgesic and anti-allergic effects, but also does not produce side effects caused by hormone drugs. Clinical studies have shown that sodium bromfenac eye drops have a good curative effect in treating postoperative inflammation of cataract, with low recurrence rate and certain therapeutic advantages, but lack of evidence-based medicine evidence. The purpose of this study is to systematically evaluate the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataracts.

METHODS

Use computer to search English and Chinese databases, such as PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, Weipu, China Biomedical Database, and Chinese Clinical Trial Registry for randomized controlled trials on the treatment of postoperative postoperative inflammation in cataract surgery with sodium bromfenac eye drops from the establishment of the database to September 2020, and data extraction and literature quality evaluation were conducted independently by two researchers, and Meta analysis was conducted on the included literature using RevMan5.3 software.

RESULTS

In this study, the efficacy and safety of sodium bromfenac eye drops in the treatment of postoperative inflammation of cataract surgery were evaluated by the effective rate, symptom score, adverse reactions, incidence, recurrence rate, etc. CONCLUSION:: This study will provide reliable evidence-based evidence for the clinical application of bromofenac sodium eye drops in the treatment of postoperative inflammation of cataract.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/3KP7R.

The influence of topical non-steroidal anti-inflammatory drugs on the intraocular pressure lowering effect of topical prostaglandin analogues-A systemic review and meta-analysis

PURPOSE

This study aimed to review previous articles and evaluate the influence of topical non-steroidal anti-inflammatory drugs (NSAIDs) on intraocular pressure (IOP) in glaucoma patients who were treated with prostaglandin analogues (PGs).

METHOD

The presenting study was designed as a meta-analysis of previous research. Databases include PubMed, Web of science, Cochrane library, and Embase were searched with keywords of "intraocular pressure, prostaglandin analogues, NSAIDs, latanoprost, travoprost, bimatoprost, tafluprost, unoprostone, latanoprostene bunod, ketorolac, diclofenac, nepafenac, bromfenac, flurbiprofen". Inclusion criteria were: 1. Study population were glaucoma patients; 2. Comparison between PGs monotherapy and PGs in combination with topical NSAIDs; 3. Changes of IOP as final outcomes. Studies with non-randomized design, treatments combining other anti-glaucomatous drugs, or unavailable absolute IOP were excluded from the analysis. Estimated difference in IOP were calculated using STATA 14.0.

RESULT

Seven studies were retrieved for this meta-analysis. Since there is a significant heterogeneity (I2 = 94%) in these studies, random-effect model was used to calculate pooled standardized mean differences (SMD). Our results showed a significantly favorable IOP lowering effect in glaucoma patients treated with combination of topical NSAIDs and PGEs (SMD: 1.3 and -0.03, 95% CI: 0.29 to 2.38 and -0.32 to 0.26, Z = 2.50 and 0.23, p = 0.013 and 0.820, respectively).

CONCLUSION

Results of our meta-analysis suggested that topical NSAIDs may enhance the IOP lowering effect of topical PGs in glaucoma patients.

Effect of topical administration of 0.1% diclofenac sodium ophthalmic solution at four frequencies on intraocular pressure in healthy Beagles

OBJECTIVE

To evaluate effects of topical ophthalmic administration of diclofenac on intraocular pressure (IOP) when applied at 4 frequencies to eyes of Beagles.

ANIMALS

8 ophthalmologically normal Beagles.

PROCEDURES

The study involved four 5-day experimental periods each separated by a 16-day washout period. During each period, 1 drop of 0.1% diclofenac sodium ophthalmic solution was administered to the right eye at 4 treatment frequencies (1, 2, 3, or 4 times/d); 1 drop of eyewash was administered to the left eye as a control treatment. A complete ophthalmic examination was performed on days 0 (day before first treatment) and 5 of each experimental period. Gonioscopy was performed on day 0 of the first period. The IOPs were measured at 7 am and 7 pm on days 1 through 5.

RESULTS

No abnormalities were detected during neuro-ophthalmic and ophthalmic examinations on day 0 of each experimental period. No adverse reactions to administration of diclofenac or eyewash were observed at any time point. No abnormalities were detected during ophthalmic examinations performed on day 5, and IOPs remained < 25 mm Hg in all 4 periods. No significant differences were identified between the treated and control eyes or among the 4 treatment frequencies.

CONCLUSIONS AND CLINICAL RELEVANCE

Topical ophthalmic administration of diclofenac up to 4 times/d in dogs with no ophthalmic abnormalities did not significantly increase the IOP. Additional research is needed to evaluate the effect of topical ophthalmic administration of diclofenac on IOP in dogs with anterior uveitis.

How many aqueous humor outflow pathways are there?

The aqueous humor (AH) outflow pathways definition is still matter of intense debate. To date, the differentiation between conventional (trabecular meshwork) and unconventional (uveoscleral) pathways is widely accepted, distinguishing the different impact of the intraocular pressure on the AH outflow rate. Although the conventional route is recognized to host the main sites for intraocular pressure regulation, the unconventional pathway, with its great potential for AH resorption, seems to act as a sort of relief valve, especially when the trabecular resistance rises. Recent evidence demonstrates the presence of lymphatic channels in the eye and proposes that they may participate in the overall AH drainage and intraocular pressure regulation, in a presumably adaptive fashion. For this reason, the uveolymphatic route is increasingly thought to play an important role in the ocular hydrodynamic system physiology. As a result of the unconventional pathway characteristics, hydrodynamic disorders do not develop until the adaptive routes cannot successfully counterbalance the increased AH outflow resistance. When their adaptive mechanisms fail, glaucoma occurs. Our review deals with the standard and newly discovered AH outflow routes, with particular attention to the importance they may have in opening new therapeutic strategies in the treatment of ocular hypertension and glaucoma.

Effect of a Topical Combination of Latanoprost and Pranoprofen on Intraocular Pressure and the Ocular Surface in Open-Angle Glaucoma Patients

Objective

A prospective study was performed to observe the effects of nonsteroidal anti-inflammatory drug (NSAID) eyedrops on intraocular pressure (IOP) and the ocular surface in primary open-angle glaucoma (POAG) patients treated with 0.005% latanoprost eyedrops.

Methods

Forty-eight subjects were randomized into two study groups (NSAID and control). Latanoprost was continued for 10 weeks in all subjects. At the end of week 4, pranoprofen was added in the NSAID group, and treatment lasted for 4 weeks, whereas patients in the control group were treated with latanoprost alone. IOP was measured in both groups every 2 weeks, and the changes in the ocular surface in the NSAID group were evaluated once a month.

Results

Pranoprofen addition resulted in a decrease in IOP in the NSAID group compared to the control group (p < 0.01). After pranoprofen was discontinued, IOP significantly increased in the NSAID group (p < 0.01), remaining approximately at the same IOP as when they were being treated with latanoprost alone. During the same examination, no significant variations in IOP were found in the control group. Patients who were treated with latanoprost alone showed gradual improvements in ocular surface symptom scores and conjunctival hyperemia scores during the first four weeks of treatment (p < 0.01). When pranoprofen eyedrops were added, ocular surface symptom scores decreased (p < 0.01), but conjunctival hyperemia scores did not change significantly.

Conclusions

For POAG patients treated with latanoprost, the combination of pranoprofen can not only significantly enhance the latanoprost-induced IOP-lowering effect but also relieve the uncomfortable ocular symptoms caused by latanoprost.

Contribution of prostanoid FP receptor and prostaglandins in transient inflammatory ocular hypertension

We explored the involvement of FP receptor and endogenous prostaglandins (PGs) in transient ocular hypertension (OH) induced by PGE2 or PGF2α in mouse eyes. PGE2 and PGF2α were topically applied to induce transient OH in Wild-type (WT) and FP-, EP1-, EP2-, and EP3-deficient (knockout [KO]) mice. To suppress endogenous PG production, the non-steroidal anti-inflammatory drug nepafenac was applied topically before treatment. PGE2 and PGF2α induced significant OH in the WT, FPKO, and EP1–3KO mice compared to the control 30 min after instillation, and the increase in IOP at 30 or 60 min after instillation in FPKO mice was significantly higher than that in the WT mice. The effects of PGF2α on the increase in IOP were significantly weaker than those of PGE2, especially in EP1KO and EP3KO mice. Transient OH induced by PGE2 and PGF2α was significantly attenuated by nepafenac treatment in FPKO mice. Transient OH was induced by PGE2 and PGF2α in WT, FPKO, and EP1–3KO mice, which was enhanced in FPKO mice. This OH was significantly diminished by nepafenac treatment in FPKO mice, suggesting that FP receptor may have an important naïve physiological role in the eye, and could regulate IOP elevation during PG-associated ocular inflammation.

Time Course of Prostaglandin Analog-related Conjunctival Hyperemia and the Effect of a Nonsteroidal Anti-inflammatory Ophthalmic Solution

PURPOSE

It is reported that nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution affected the therapeutic efficacy of prostaglandin (PG) analog by inhibiting endogenous PG production. However, whether NSAID ophthalmic solution interferes with its conjunctival hyperemia is unknown. We investigated the effect of NSAID ophthalmic solution on its hyperemia.

MATERIALS AND METHODS

This was a prospective, randomized, double-blind, placebo-controlled 1-month trial. Benzalkonium chloride-free travoprost 0.004% was used as a PG analog and administered once daily (08:00) in both eyes. Bromfenac sodium hydrate was assigned randomly to 1 eye twice daily (08:00 and 20:00) (the NSAID side), whereas flavin adenine dinucleotide sodium was applied to the fellow eye of each patient twice daily (08:00 and 20:00) (the control side). Conjunctival photographs of both eyes were taken 3 times (08:00, 14:00, 20:00) on days 1, 2, 7, and 28, and hyperemia was scored from 0 to 5 (H-score). We compared H-scores on the NSAID and control sides.

RESULTS

Twenty-eight Japanese normal subjects completed the study. The H-score on the NSAID side was significantly lower than that on the control side on day 1 at 14:00 (P=0.016, paired t test) and day 2 at 14:00 (P=0.016). But there were no differences at 20:00 on each day and after that time.

CONCLUSIONS

The use of NSAID ophthalmic solution had almost no impact on PG analog-related conjunctival hyperemia. This partly suggests that the action mechanism of endogenous PG after administrating PG analog might be no correlation with conjunctival hyperemia.

Effect of Travoprost and Nonsteroidal Anti-Inflammatory Drug on Diurnal Intraocular Pressure in Normal Subjects with Low-Teen Baseline Intraocular Pressure

PURPOSE

The main purpose was to determine whether a nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution would affect the intraocular pressure (IOP)-lowering effect of a benzalkonium chloride (BAK)-free prostaglandin analog, travoprost. The secondary purpose was to confirm the IOP-lowering effect of BAK-free travoprost on the diurnal IOP.

METHODS

This was a prospective, randomized, double-blind, placebo-controlled 1-month trial. After baseline diurnal IOP was confirmed, travoprost was administered once daily to both eyes. Bromfenac sodium hydrate was then randomly assigned to one eye, while flavin adenine dinucleotide sodium was applied to the other eye as a control. Both solutions were administered twice daily. IOP was measured three times daily (8:00, 14:00, and 20:00). The IOP of both groups was compared using Student's t-test. The effect of NSAID on IOP was investigated by repeated measures analysis of variance (ANOVA).

RESULTS

Twenty-eight normal Japanese subjects (mean age, 36.6 years) completed the study. After the start of travoprost, remarkable IOP lowering was gained and it settled to 10-11 mmHg. The diurnal IOPs of the NSAID group showed similar tendencies to that of the control group (P = 0.69-1.0). In a 1-month period, the range of IOP reductions compared with the baseline IOP of both groups showed no significant difference (P = 0.76-0.92). NSAID did not have an influence on IOP (F-value = 0.0036, P = 0.95).

CONCLUSIONS

Although BAK-free travoprost showed a powerful IOP-lowering effect in diurnal and 1-month readings, even in eyes with an IOP of <13 mmHg, the NSAID ophthalmic solution did not affect its IOP-lowering effect.

Effect of nepafenac eye drops on intraocular pressure: a randomized prospective study

PURPOSE

To report the effect of nepafenac (0.1%) eye drops on intraocular pressure in eyes with cataract.

DESIGN

Prospective randomized clinical trial.

METHODS

Three hundred and twenty-seven patients with bilateral cataracts in an institutional setting were included. All patients had a baseline intraocular pressure (IOP) ≤ 21 mm Hg without a history of intraocular surgery in the past 3 months. One eye of each individual was randomized to the treatment group, with the other eye acting as a control. Nepafenac (0.1%) eye drops were instilled 3 times a day in the eye that received treatment. Intraocular pressure (IOP) with Goldmann applanation tonometer (GAT) was measured at baseline and at 4 and 8 weeks. Proportion of eyes with an IOP elevation of >4 mm Hg was the main outcome measure.

RESULTS

The mean age of the participants was 45.7 ± 4.4 years. Participants included 192 female and 135 male patients. The mean IOP at baseline in the treated and control eyes was, respectively, 13.8 ± 2.5 mm Hg and 13.4 ± 3.0 mm Hg, which reduced to 12.0 ± 2.0 mm Hg and 12.1 ± 1.5 mm Hg, respectively, at the end of 8 weeks. This reduction in IOP in both groups was significant (P < .01). The difference between the IOP in the treated and control eyes at 8 weeks was not statistically significant (P = .34). One eye in the treated group and 2 eyes in the control group had an IOP elevation of >4 mm Hg.

CONCLUSION

Nepafenac eye drops do not increase the IOP. They can possibly be used as an alternative to steroid medications where steroid responsiveness is a concern.

Endogenous Bioactive Lipids and the Regulation of Conventional Outflow Facility

Perturbation of paracrine signaling within the human conventional outflow pathway influences tissue homeostasis and outflow function. For example, exogenous introduction of the bioactive lipids, sphingosine-1-phosphate, anandamide or prostaglandin F(2α), to conventional outflow tissues alters the rate of drainage of aqueous humor through the trabecular meshwork, and into Schlemm's canal. This review summarizes recent data that characterizes endogenous bioactive lipids, their receptors and associated signaling partners in the conventional outflow tract. We also discuss the potential of targeting such signaling pathways as a strategy for the development of therapeutics to treat ocular hypertension and glaucoma.

Effect of topical 0.03% flurbiprofen and 0.005% latanoprost, alone and in combination, on normal canine eyes

OBJECTIVE

Evaluate the influence of topically applied flurbiprofen 0.03% and latanoprost 0.005%, alone or in combination, in normal canines.

ANIMALS STUDIED

  10 Normal Beagles.

PROCEDURES

Intraocular pressure (IOP), pupil size, aqueous flare, conjunctival hyperemia, and blepharospasm were evaluated bilaterally five times daily (8 am, 11 am, 2 pm, 5 pm, and 8 pm). The study consisted of a training and acclimation period, followed by 3, 1-week experiment periods. A 2-week washout period occurred between each experiment period. During period 1, all dogs received flurbiprofen (three doses 6-h apart) in the treated eye, whereas in period 2, all dogs received latanoprost (one dose 24-h apart). During period 3, both latanoprost (one dose 24-h apart) and flurbiprofen (three doses 6-h apart) were administered in the treated eye.

RESULTS

Flurbiprofen resulted in a mean IOP elevation of 1.1 mmHg (8.65%) in the treated eye, as compared with the control eye. No effect on pupil size, conjunctival hyperemia, or aqueous flare was noted. Latanoprost resulted in a mean IOP reduction of 3.4 mmHg (30.19%). Combined latanoprost and flurbiprofen resulted in a mean IOP reduction of 2.7 mmHg (24.56%). Miosis was noted in the treated eyes during both latanoprost periods, with maximal pupil constriction 3-h post-dose. This was followed by relative mydriasis 24-h post-dose, persisting 48 h after the last dose. The degree of conjunctival hyperemia varied between individuals. Neither blepharospasm nor aqueous flare was noted at any time point.

CONCLUSION

Concurrent administration of latanoprost and flurbiprofen resulted in a 20.41% reduction in the ocular hypotensive effect relative to latanoprost therapy alone.

The side effects of the prostaglandin analogues

In the last decade topically applied prostaglandin F2alpha analogues (bimatoprost, latanoprost, travoprost and unoprostone) have become widely used as a means to reduce elevated intraocular pressure in patients with glaucoma and ocular hypertension. These molecules all have similar side-effect profiles, which include both side effects that occur frequently (e.g., conjunctiva hyperaemia, increase of iris pigmentation and eyelash changes) and rare adverse reactions (e.g., periocular pigmentation, damage to the blood-aqueous barrier and cystoid macular oedema). Conjunctiva hyperaemia, eyelash changes and cystoid macular oedema are reversible, but certain other side effects, such as increased iris pigmentation, are not. However, the systemic side-effect profile is favourable for all the prostaglandin analogues, and some of the local side effects are only of cosmetic significance. Numerous clinical studies suggest that discontinuing treatment with prostaglandin analogues on account of their side effects is rare in clinical practice.