title: Prostaglandin E2 inhibition of ketorolac 0.45%, bromfenac 0.09%, and nepafenac 0.1% in patients undergoing phacoemulsification.
abstract: BACKGROUND
  We compared the prostaglandin E(2) (PGE(2)) inhibition of three topical nonsteroidal antiinflammatory drugs (NSAIDs): ketorolac 0.45%, bromfenac 0.09%, and nepafenac 0.1% at peak dosing levels in patients previously scheduled to undergo phacoemulsification.
  
  
  METHODS
  This was a single-center, double-masked observational study of 121 patients randomized to one of three NSAID treatment arms. Patients were instructed to take the NSAID per on-label dosing (twice daily [b.i.d.] for ketorolac 0.45% and bromfenac 0.09%, three times a day [t.i.d.] for nepafenac 0.1%) for 1 day before surgery, and were to instill one drop the morning of surgery. Each patient received an additional four doses 1 hour prior to undergoing phacoemulsification. After completion of the paracentesis site with a super blade, aqueous humor (0.15 mL) was collected through the peripheral clear cornea with a 30 G needle attached to a tuberculin (TB) syringe. Aqueous humor samples were stored at -40°C prior to analysis, and diluted 1:10 with diluent. Assays were conducted on multiple plates in duplicate (seven standards per plate).
  
  
  RESULTS
  The mean (±SD) PGE(2) concentrations were 224.8±164.87 pg/mL for ketorolac 0.45% (n=42), 288.7±226.05 pg/mL for bromfenac 0.09% (n=41), and 320.4±205.6 pg/mL for nepafenac 0.1% (n=38). The difference between ketorolac 0.45% and nepafenac 0.1% was statistically significant (P=0.025). The difference between bromfenac 0.09% and nepafenac 0.1% was not significantly different (P=0.516).
  
  
  CONCLUSIONS
  Ketorolac 0.45% achieved the greatest inhibition of PGE(2) compared to nepafenac 0.1% and bromfenac 0.09%. Ketorolac 0.45% may be more efficacious at controlling inflammation at the time of cataract surgery versus nepafenac 0.1% and bromfenac 0.09%.
authors: Bucci Laser Vision Institute, Wilkes-Barre, PA 18702, USA. buccivision@aol.com
authors: Frank A
authors: FA
authors: Bucci
authors: L David
authors: LD
authors: Waterbury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology* / Q000627:therapeutic use; D044482:Benzeneacetamides / Q000494:pharmacology* / Q000627:therapeutic use; D001577:Benzophenones / Q000494:pharmacology* / Q000627:therapeutic use; D001969:Bromobenzenes / Q000494:pharmacology* / Q000627:therapeutic use; D015232:Dinoprostone / Q000037:antagonists & inhibitors* / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000494:pharmacology / Q000627:therapeutic use; D018918:Phacoemulsification / Q000379:methods*; D010648:Phenylacetates / Q000494:pharmacology* / Q000627:therapeutic use
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