June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
A comparison of ketorolac, diclofenac, nevanac, flurbiprofen, and bromfenac in the treatment of cystoid macular edema: a retrospective analysis
Author Affiliations & Notes
  • Jenna M Kim
    Ophthalmology, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Omar Shakir
    Ophthalmology, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Ron A Adelman
    Ophthalmology, Yale New Haven Hospital, New Haven, Connecticut, United States
  • Footnotes
    Commercial Relationships   Jenna Kim, None; Omar Shakir, None; Ron Adelman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4634. doi:
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      Jenna M Kim, Omar Shakir, Ron A Adelman; A comparison of ketorolac, diclofenac, nevanac, flurbiprofen, and bromfenac in the treatment of cystoid macular edema: a retrospective analysis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4634.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : A number of studies have been published to date comparing the efficacy of various systemic and topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular edema (CME), but literature lacks head-to-head comparison of the various commercially available topical NSAIDs. We performed a retrospective observational clinical study to elucidate the clinical differences between patients with CME who were treated with various topical NSAIDs including ketorolac, diclofenac, flurbiprofen, nevanac, and bromfenac for cystoid macular edema.

Methods : Total of 20 eyes of 17 patients ranging from age 45 to 88 at the time of CME diagnosis were included. The underlying cause of the patients included Irvine-Gass syndrome, chronic uveitis, and prostaglandin-analogue use for glaucoma treatment. Patients whose standard treatment for their macular edema was not the use of topical NSAIDs (e.g., diabetic macular edema, age-related macular degeneration, epiretinal membrane) were excluded. Primary endpoints were best-corrected visual acuity and central macular thickness. Endpoints were recorded for the time of diagnosis, 1 month after, and 6 months after the diagnosis.

Results : Of the 20 eyes in the study so far, 10 eyes were treated with nepafenac, 2 eyes were treated with diclofenac, 4 eyes were treated with ketorolac and 4 eyes were treated with flurbiprofen. Bromfenac was used in only one eye, so the result is excluded from this analysis. Average initial visual acuity was logMAR 0.53 for nepafenac group, 0.6 for diclofenac, 0.73 for ketorolac, and 0.46 for flurbiprofen. Visual acuity at month 6 was 0.21 in the nepafenac group, 0.65 in the diclofenac group, 0.2 in the ketorolac group, and 0.45 in the flurbiprofen group. The central macular thickness by 6 months was reduced by 134 microns in the nepafenac group, 31 microns in the diclofenac group, 254 microns in the ketorolac group, and 92 microns in the flurbiprofen group.

Conclusions : With this data based on only 20 eyes, a definitive conclusion is difficult to draw. Nepafenac and ketorolac seem promising in their efficacy in reducing central macular thickness and visual acuity at 6 months after the onset of CME. Prospective studies are recommended.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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