Bromfenac reduces cystoid macular edema in cataract

Boston-Bromfenac ophthalmic solution 0.09% (Xibrom, ISTA Pharmaceuticals) is effective for preventing pseudophakic cystoid macular edema (CME) when instilled 3 days before phacoemulsification and IOL implantation and then following surgery.

Bromfenac 0.09% is a topical ophthalmic nonsteroidal anti-inflammatory drug (NSAID) that is indicated for the treatment of inflammation and ocular pain after cataract surgery. The drug is thought to work by inhibiting prostaglandin synthesis by inhibiting cyclooxygenase 1 and 2.

Melissa M. Cable, MD, reported the results of a large retrospective study of the NSAID at the annual meeting of the American Society of Cataract and Refractive Surgery.

The study was a retrospective review of 1,020 charts of all patients who had undergone uneventful phacoemulsification and IOL implantation performed by one surgeon over a 30-month period. The patients instilled bromfenac 0.09% twice a day starting 3 days before the scheduled surgery and then twice a day postoperatively until the supply was finished.

Visual acuity was evaluated postoperatively on day 1, and weeks 1 and 6, and at any other visits. One week postoperatively, the patients underwent a dilated fundus examination. Any patients with decreased vision or any remarkable findings on the fundus examination were referred for macular optical coherence tomography (OCT), fluorescein angiography, or both, Dr. Cable said.

Among the 1,020 eyes included in the study, five eyes (0.5%) of three patients were confirmed to have pseudophakic CME based on the findings on OCT images. In two of the cases, fluorescein angiography was performed to confirm the findings. One patient had a documented pre-existing epiretinal membrane. The mean patient age was 66 years.

Dr. Cable said that symptomatic pseudophakic CME developed at a mean of 5 weeks. The mean logMAR visual acuity at onset was –0.416 (about 20/50). The pseudophakic CME resolved at a mean of 7.6 weeks after onset, which was confirmed on OCT images. The final logMAR best-corrected visual acuity was –0.15 (slightly better than 20/30). There were no adverse ocular or systemic events associated with treatment with bromfenac 0.09%.

Based on the results, Dr. Cable concluded that bromfenac 0.09% when prescribed twice daily beginning 3 days before phacoemulsification and lens implantation and then twice daily after surgery until the drug supply is finished appears to be highly effective in preventing pseudophakic CME.

"In this study, pseudophakic CME developed in two patients without systemic or ocular risk factors. Treatment of pseudophakic CME with bromfenac 0.09% appears to be an effective way to reduce the signs of CME as seen on OCT images and improve the visual acuity," said Dr. Cable, from observations in the clinic.

Bromfenac is being reviewed by the FDA for once-daily application for the treatment of inflammation and ocular pain after cataract surgery, the company reported in April.

FYI

Melissa M. Cable, MD
E-mail: mcable@discovervision.com

Dr. Cable has a proprietary interest in the
subject matter.