Topical bromfenac as an adjunctive treatment with intravitreal ranibizumab for exudative age-related macular degeneration.
OBJECTIVE
Intravitreal injection of ranibizumab is highly effective for wet age-related macular degeneration. Its limitation is that most patients require repeated intravitreal injections to achieve and maintain the visual gain. We assessed the effectiveness of adjunctive topical bromfenac, a nonsteroidal antiinflammatory drug, with ranibizumab.


METHODS
Patients with wet age-related macular degeneration with lesions smaller than 2 disk diameters were randomized 2:3 to adjunctive topical bromfenac (n = 16) or sham (n = 22) and a 0.5-mg ranibizumab injection in a double-masked fashion. Subjects were examined monthly, and ranibizumab was injected as needed from baseline. The primary endpoint was the comparison of the number of ranibizumab injections over 6 months. The visual and anatomic responses also were compared.


RESULTS
The mean number of ranibizumab injections over 6 months was 2.2 in the bromfenac group and 3.2 in the sham, a difference that reached significance (P = 0.0274). The changes in visual acuity did not differ significantly (P = 0.3141) although the central retinal thickness was tended to decrease more in bromfenac group (P = 0.0604). Multivariate analysis showed that topical bromfenac is significantly associated with fewer ranibizumab injections.


CONCLUSIONS
Topical bromfenac might reduce the frequency of ranibizumab over 6 months in eyes with relatively small age-related macular degeneration lesions.
Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan. fgomi@ophthal.med.osaka-u.ac.jp
Fumi
F
Gomi
Miki
M
Sawa
Motokazu
M
Tsujikawa
Kohji
K
Nishida
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001577:Benzophenones / Q000008:administration & dosage*; D001969:Bromobenzenes / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005122:Exudates and Transudates; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
D020533:Angiogenesis Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D061067:Antibodies, Monoclonal, Humanized; D001577:Benzophenones; D001969:Bromobenzenes; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C053083:bromfenac; D000069579:Ranibizumab