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Angela Herro, Michael A. Singer, Jennifer A. Luth, Simon P. Chandler; Analysis of Corneal Health in Patients on Long Term Topical NSAID Therapy with Dry Eye Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4328.
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To evaluate the effect on corneal health of long-term topical NSAID therapy in patients with a diagnosis of dry eye diagnosis. To date, no large scale studies examining the safety profile of topical NSAIDS with dry eye patients have been conducted.
A retrospective analysis was conducted on 541 patients who received greater than one prescription of XibromTM. Of these, 178 patients were diagnosed with dry eye disease concomitant with chronic topical NSAID therapy for secondary ocular conditions. Dry eye disease in patients was diagnosed by slit lamp examination. Dry eye diagnosis was recorded in cornea exam field of the patient record. Subsequent treatment documentation included artificial tears or cyclosporine for dry eye therapy. The primary diagnosis for topical NSAID therapy along with any corneal adverse changes and autoimmune co-morbidities were recorded.
Of the 178 patients diagnosed with dry eye, the average length of time on bromfenac was 12.45 months with an additional average time of 2.89 months on either ketorolac or nepafanac. There were 27 patients with corneal adverse events noted during their treatment with bromfenac but none of the corneal events were directly related to the long term use of bromfenac. The most frequently occurring were punctate keratitis in 6 patients, 5 patients status post LASIK, and 5 with endothelial dystrophy.
As evidenced by the presence of a warning in the package inserts for currently available NSAIDs, dry eye is suggested to be a risk factor for the development of corneal complications with NSAID use. The subject population described here did not exhibit a preponderance of complications due to dry eye. Indeed, in our practice, 35% of patients had a dry eye diagnosis as a co-morbidity and yet, none developed corneal complication or melts during long term topical NSAID use.
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