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L.M. Amico, F.A. Bucci, Jr., D. Waterbury; Aqueous PGE2 Inhibition of Ketorolac 0.4% vs. Nepafenac 0.1% in Patients Undergoing Phacoemulsification . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2602.
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To determine and evaluate the PGE2 inhibition of 2 topical NSAIDs [ketorolac tromethamine 0.4%, (Acular LS) and nepafenac 0.1% (Nevanac)] in phaco patients.
Single center, randomized, double–masked study of 60 patients randomized to receive either ketorolac 0.4% or nepafenac 0.1% 4 times daily for 2 days preoperatively and every 10 minutes x 4 in the hour immediately prior to phacoemulsification. After completion of the paracentesis site with a superblade, aqueous humor (.15cc) was collected through the peripheral clear cornea with a 30 gage needle attached to a TB syringe. Following collection, aqueous samples were stored T –60º C prior to analysis. Aqueous humor was diluted 1:10 in buffer, and then assayed in triplicate for PGE2 by using a competitive enzyme immunoassay using a monoclonal antibody. The product of the assay enzymatic reaction was determined using a plate reader set at 405nM.
In a preliminary analysis of 53 patients (n=25 ketorolac and n=28 nepafenac), ketorlac–treated eyes were statistically significantly more likely to be below the level of detection (<100 pg/ml) than nepafenac–treated eyes [16/25 (64%) of ketorolac–treated eyes, compared with 7/28 (25%) of nepafenac eyes, (p=.004)]. In the remaining samples, the mean PGE2 value in the ketorolac–treated eyes (n=9) was 305 ± 155.2 pg/ml and 385 ± 173.3 pg/ml in the nepafenac–treated eyes (n = 21) (p=.198).
The findings of this preliminary analysis suggests that ketorolac 0.4% may inhibit aqueous PGE2 to a greater extent than nepafenac 0.1% post phacoemulsification . Further analysis will be performed to confirm these findings.
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