NSAIDs in combination therapy for the treatment of chronic pseudophakic cystoid macular edema.
OBJECTIVE
The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema.


METHODS
Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks.


RESULTS
At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy.


CONCLUSIONS
Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.
Warren
Keith A
KA
Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas, USA. kwarren@warrenretina.com
Bahrani
Hasan
H
Fox
Jenni E
JE
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D044482:Benzeneacetamides / Q000627:therapeutic use; D001577:Benzophenones / Q000627:therapeutic use; D000068258:Bevacizumab; D001969:Bromobenzenes / Q000627:therapeutic use; D004008:Diclofenac / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D020910:Ketorolac / Q000627:therapeutic use; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010648:Phenylacetates / Q000627:therapeutic use; D019591:Pseudophakia / Q000150:complications*; D012160:Retina / Q000473:pathology; D016037:Single-Blind Method; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014822:Vitreous Body
D020533:Angiogenesis Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D044482:Benzeneacetamides; D001577:Benzophenones; D001969:Bromobenzenes; D005938:Glucocorticoids; D010648:Phenylacetates; D042461:Vascular Endothelial Growth Factor A; C414203:nepafenac; D004008:Diclofenac; D000068258:Bevacizumab; C053083:bromfenac; D014222:Triamcinolone Acetonide; D020910:Ketorolac