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Topical Bromfenac for Pseudophakic Cystoid Macular Edema – Case Reports

Published Online: August 5th 2012 European Ophthalmic Review, 2012;6(4):230-5 DOI: http://doi.org/10.17925/EOR.2012.06.04.230
Authors: George Voyatzis, Anil Pitalia, Colin Vize, Madhavan Rajan
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Abstract:
Overview

Cystoid macular edema (CME) is the most common cause of visual loss following uncomplicated cataract surgery and although the condition usually resolves itself within several months, it can result in permanent vision loss in a minority of patients. There is a lack of consensus in diagnostic methods and definition of the condition and as a result, estimates of its incidence vary greatly, ranging from 4 to 41 %. There is also a scarcity of randomised controlled trial data to support the efficacy of ophthalmic agents in the prophylaxis and treatment of CME. However, a growing body of evidence supports the use of topical non-steroidal anti-inflammatory drugs (NSAIDs) both pre-and post-surgery. The importance of the prophylactic use of NSAIDs should be emphasized as many cases of CME are preventable. The combination of corticosteroids and NSAIDs may be more effective than either class of agents alone. The use of bromfenac for the treatment and prevention of CME is growing. Its unique chemical structure makes it highly lipophilic with rapid penetration of ocular tissues; it has sustained anti-inflammatory action and allows less frequent dosing (twice a day as opposed to three or four times a day). This article presents four case studies detailing rapid CME resolution following topical administration of bromfenac.

Keywords

Bromfenac, cataract surgery, cystoid macular edema, non-steroidal anti-inflammatory drugs, phacoemulsification

Article:

Cataract removal is one of the most commonly performed surgeries and in recent years has benefited from advances in technique, lens design and instrumentation.1 Phacoemulsification surgery via small incisions and implantation of a foldable intraocular lens (IOL) is an effective procedure, and provides good visual outcomes.2–5

Post-operative complications of cataract surgery however, may occur, including cystoid macular edema (CME) which is the most common cause of visual loss following cataract surgery.6–8 It is more common in patients with ocular diseases such as uveitis or diabetic retinopathy and after complicated or uncomplicated surgery in patients with otherwise healthy eyes.9 The development of small incision cataract surgery and phacoemulsification techniques has lowered the incidence of CME, but the total volume of cataract surgeries makes it a common morbidity. Up to 80 % of symptomatic patients show spontaneous improvement in visual function three to 12 months post surgery. In a minority of patients, CME requires treatment and in some cases, it may be refractory to treatment.10

Prevention of CME through post-operative use of NSAIDs is now standard of care in the US and increasingly practiced in several other countries around the world. In addition, there have been several clinical studies that support the role of NSAIDs in helping prevent CME.8,10–15

This review considers the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of CME with a focus on bromfenac. Four case reports of rapid CME resolution after topical administration of bromfenac are discussed.

Definition, Incidence and Cost
CME can be detected using either clinical or angiographic methods. Clinical CME is diagnosed using slit-lamp biomicroscopic observation of cystoid abnormalities or angiographic evidence of perifoveal leakage as well as reduced visual acuity (VA). The angiographic CME is diagnosed using fluorescein angiography. The incidence of clinical CME is low, ranging from 0 to 4 %.16 The incidence of angiographic CME is higher; incidence rates of 19,15 2217 and 9 %18 have been reported.

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Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Madhavan Rajan, Professor of Ophthalmic and Visual Sciences, Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Easting 204, East Road, Cambridge, CB1 1PT, UK. E: madhavan.rajan@addenbrookes.nhs.uk

Support

The publication of this article was funded by Bausch & Lomb. The views and opinions expressed are those of the authors and not necessarily those of Bausch & Lomb.

Received

2012-09-22T00:00:00

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