title: Vitreous nonsteroidal antiinflammatory drug concentrations and prostaglandin E2 levels in vitrectomy patients treated with ketorolac 0.4%, bromfenac 0.09%, and nepafenac 0.1%.
abstract: OBJECTIVE
  To assess vitreous concentrations of nonsteroidal antiinflammatory drugs (NSAIDs) and prostaglandin E(2) in patients treated with NSAIDs before vitrectomy.
  
  
  METHODS
  This was an investigator-masked, randomized, multicenter study. Patients received ketorolac 0.4% 4 times a day, bromfenac 0.09% 2 times a day, nepafenac 0.1% 3 times a day, or no NSAID for 3 days before surgery. Nonsteroidal antiinflammatory drugs and prostaglandin E(2) levels were determined in vitreous samples collected at the beginning of surgery.
  
  
  RESULTS
  Thirty-one patients were included in the analyses. The mean (SD) vitreous concentrations were as follows: ketorolac 2.8 (3.2) ng/mL, bromfenac 0.96 (0.31) ng/mL, nepafenac 1.1 (0.6) ng/mL, and amfenac 2.0 (0.8) ng/mL aligned with the initial concentrations of the topical NSAIDs. Mean (SD) vitreous prostaglandin E(2) levels of the control patients and those treated with ketorolac 0.4%, bromfenac 0.09%, or nepafenac 0.1% were 270.6 (91.7) pg/mL, 189.6 (50.2) pg/mL, 247.2 (38.3) pg/mL, and 267.7 (99.7) pg/mL, respectively. Patients treated with ketorolac 0.4% had significantly lower prostaglandin E(2) levels than those treated with no NSAID (P = 0.047) or nepafenac 0.1% (P = 0.028).
  
  
  CONCLUSIONS
  All three NSAIDs penetrated into the vitreous cavity. Topical therapy with ketorolac may lower preoperative vitreous prostaglandin E(2) levels, which may have a clinical impact on the management of prostaglandin-mediated diseases, including cystoid macular edema.
authors.affiliation: Ophthalmic Consultants of Boston, Boston, Massachusetts 02114, USA. jsheier@eyeboston.com
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heier
authors.forename: Carl C
authors.initials: CC
authors.lastname: Awh
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Busbee
authors.forename: L David
authors.initials: LD
authors.lastname: Waterbury
authors.forename: Paul
authors.initials: P
authors.lastname: Daniel
authors.forename: Glenn L
authors.initials: GL
authors.lastname: Stoller
authors.forename: Tina S
authors.initials: TS
authors.lastname: Cleary
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000493:pharmacokinetics*; D044482:Benzeneacetamides / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001577:Benzophenones / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001682:Biological Availability; D001969:Bromobenzenes / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002851:Chromatography, High Pressure Liquid; D015232:Dinoprostone / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010648:Phenylacetates / Q000008:administration & dosage / Q000493:pharmacokinetics*; D012164:Retinal Diseases / Q000601:surgery; D014018:Tissue Distribution; D014821:Vitrectomy; D014822:Vitreous Body / Q000378:metabolism*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D044482:Benzeneacetamides; D001577:Benzophenones; D001969:Bromobenzenes; D009883:Ophthalmic Solutions; D010648:Phenylacetates; C414203:nepafenac; C053083:bromfenac; D015232:Dinoprostone; D020910:Ketorolac