Inhibition of choroidal neovascularization by intravitreal ketorolac.
OBJECTIVE
To determine the inhibitory effect of intravitreal nonsteroidal anti-inflammatory drugs on choroidal neovascularization (CNV) in an animal model of age-related macular degeneration.


METHODS
Six laser burns of sufficient power to rupture the Bruch membrane were induced in the peripapillary area of each eye of 18 adult Brown Norway rats. Both eyes of each animal received the same 5-microL intravitreal injection of 30 mg/mL of ketorolac tromethamine, 40 mg/mL of triamcinolone acetonide, or balanced salt solution. Fluorescein angiography was performed on days 14 and 21 after injection, animals were euthanized, and retinal pigment epithelium-choroid-sclera (choroidal) flat mounts were prepared. Areas of abnormal vascular leakage on fluorescein angiography and vascular budding on choroidal mounts were measured and quantified using an image analysis program.


RESULTS
Intravitreal ketorolac significantly reduced CNV leakage on fluorescein angiography at 2 (P < .001) and 3 (P = .006) weeks compared with eyes injected with balanced salt solution, but intravitreal triamcinolone was a more potent inhibitor of CNV leakage than ketorolac (P < .001). Vascular budding on choroidal mounts was almost entirely suppressed with triamcinolone (P < .001) and significantly inhibited with ketorolac (P = .009).


CONCLUSIONS
Intravitreal ketorolac significantly reduced laser-induced CNV leakage and vascular budding as determined by fluorescein angiography and choroidal flat mounts, respectively, although this effect was less than that of triamcinolone.


CONCLUSIONS
Intravitreal nonsteroidal anti-inflammatory drugs may be useful in the treatment of CNV owing to age-related macular degeneration or other causes and offer distinct clinical advantages over corticosteroids because of their lack of association with cataract formation or glaucoma.
Kim
Stephen J
SJ
Department of Ophthalmology & Visual Sciences, Vanderbilt University, Nashville, Tennessee, USA. skim30@gmail.com
Toma
Hassanain S
HS
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002199:Capillary Permeability / Q000187:drug effects; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy*; D004195:Disease Models, Animal; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage; D007267:Injections; D020910:Ketorolac / Q000008:administration & dosage*; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D051381:Rats; D011914:Rats, Inbred BN; D014222:Triamcinolone Acetonide / Q000008:administration & dosage; D014822:Vitreous Body
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D020910:Ketorolac