title: Efficacy and vitreous levels of topical NSAIDs.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications and are routinely used for their analgesic, antipyretic, and anti-inflammatory properties. Because of their potent cyclooxygenase-inhibitory activity, they can inhibit pro-inflammatory prostaglandin synthesis, leading to complex inflammatory cascades. NSAIDs have been broadly used systemically for many decades and have recently become commercially available in the form of topical ophthalmic formulations. NSAIDs are weak acids with pKa values mostly between 3.5 and 4.5 and are poorly water-soluble. New, aqueous ophthalmic solutions of NSAIDs that afford better tissue penetration have recently been developed. In ophthalmological practice, topical NSAIDs are mostly used to stabilize pupillary dilation during intraocular surgery, manage postoperative pain and inflammation, and treat pseudophakic cystoid macular edema.
  
  
  METHODS
  This review focuses on the vitreous penetration of topical NSAIDs and their potential clinical applications in the treatment of retinal diseases.
  
  
  CONCLUSIONS
  A growing body of evidence suggests that NSAIDs may be beneficial in the treatment of age-related macular degeneration, diabetic retinopathy, and ocular tumors. Recent studies from our group and other authors have shown that the vitreous levels of NSAID exceed the median inhibitory concentration, which can significantly decrease vitreous PGE2 levels.
authors.affiliation: a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ; dott.andrea.russo@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
authors.affiliation: a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ; dott.andrea.russo@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.affiliation: a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ; dott.andrea.russo@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Gambicorti
authors.affiliation: a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ; dott.andrea.russo@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Duse
authors.affiliation: a 1 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic , Brescia, Italy +390303995308 ; +390303388191 ; dott.andrea.russo@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Morescalchi
authors.affiliation: b 2 University of Brescia, Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Forensic Medicine , Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Vezzoli
authors.affiliation: c 3 University of Molise, Department of Medicine and Health Sciences , Campobasso, Italy.|d 4 I.R.C.C.S Neuromed, Località Camerelle , Pozzilli (Isernia), Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003930:Diabetic Retinopathy / Q000188:drug therapy; D005123:Eye / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D008268:Macular Degeneration / Q000188:drug therapy; D008269:Macular Edema / Q000188:drug therapy; D009883:Ophthalmic Solutions; D012164:Retinal Diseases / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions
keywords: NSAIDs; inflammation; retinal disease; vitreous penetration