Topical Nonsteroidal Antiinflammatory Drugs in Ophthalmology

Flach, Allan J.

doi:10.1097/00004397-200201000-00003

Cited by 105 publications

(63 citation statements)

References 40 publications

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“…[5][6][7][8] Clinical trials suggest NSAIDs are an effective alternative to steroid therapy. 1,[9][10][11][12][13] Preventing inflammation by treating with topical NSAIDs before surgery has theoretical and practical appeal. When NSAIDs are used preoperatively, inhibition of prostaglandin synthesis may prevent inflammation.…”

mentioning

confidence: 99%

“…This treatment regimen will provide therapeutic levels of drug at the time of surgical insult in the early postoperative period and will more closely replicate how NSAIDs are used in today's surgical setting. 9 This study was designed to determine whether nepafenac ophthalmic suspension 0.1%, used as the sole postoperative treatment, effectively decreases the incidence and severity of the inflammation and pain that occur after cataract surgery with IOL implantation.…”

mentioning

confidence: 99%

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Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery

Lane¹,

Modi²,

Lehmann³

et al. 2007

Journal of Cataract and Refractive Surgery

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mentioning

confidence: 99%

mentioning

confidence: 99%

Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery

Lane¹,

Modi²,

Lehmann³

et al. 2007

Journal of Cataract and Refractive Surgery

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“…1 Some patients can have surgery even with no inflammation, but it is not possible to date to predict such outcome and therefore antiinflammatory agents are routinely used in nearly all patients. Even if both steroidal and nonsteroidal antiinflammatory drugs have been successful utilised in the control of postoperative inflammation, 2,20,[25][26][27] corticosteroids offer the widest range of activity by ameliorating the effect of the preformed mediators of inflammation as well as attenuating the release of newly formed mediators. 28 Therefore, they still form the mainstay of the anti-inflammatory management of cataract extraction.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone–netilmicin: a new ophthalmic steroid–antibiotic combination. Efficacy and safety after cataract surgery

Russo¹,

Papa²,

Bella³

et al. 2005

Eye

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Purpose The purpose of this study was to evaluate both efficacy and safety of a new ophthalmic steroid-antibiotic fixed combination containing dexamethasone and netilmicin in the postsurgical management of cataract surgery. Methods In total, 223 patients were randomly treated with dexamethasone 1 mg/ml plus netilmicin 3 mg/ml (n ¼ 148), or dexamethasone 1 mg/ml plus tobramycin 3 mg/ ml (n ¼ 75, TOBRADEX s ) four times in a day for 771 days starting immediately after surgery. Efficacy (anterior chamber (AC) inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia and tearing) and safety (burning, stinging, blurred vision, intraocular pressure, and visual acuity) were analysed in the operated eye after 1 and 771 days. A followup visit was performed at day 1472. The extent of AC inflammation, measured by slitlamp according to a standard scoring system, was used as primary efficacy parameter. Results At the primary end point (day 7) both fixed combinations were equally effective in reducing postoperative inflammation. The safety profile of the dexamethasone/netilmicin combination was excellent with no evidence of poor local tolerance or adverse reaction. Conclusions A new fixed combination of dexamethasone and netilmicin was effective and safe in controlling ocular inflammation after cataract surgery.

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“…Although corneal complications following NSAID use are uncommon, 22 NSAIDs have been associated with corneal effects, such as keratitis and involved in clinical studies experienced adverse reactions when receiving nepafenac, leading to discontinuation in 0.6 % of patients. 23 This was less, however, than the discontinuation of patients receiving placebo (1.3 %).…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Nepafenac in the Prevention and Treatment of Ocular Inflammation and Pain Following Cataract Surgery and in the Prevention of Post-operative Macular Oedema in Diabetic Patients

Nardi¹

2012

European Ophthalmic Review

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Nepafenac ophthalmic suspension is a topical non-steroidal anti-inflammatory drug (NSAID) approved in the US and Europe for prevention and treatment of post-operative pain and inflammation associated with cataract surgery, and recently approved in Europe for reduction in risk of post-operative macular oedema associated with cataract surgery in diabetic patients. Unlike conventional NSAIDs, nepafenac is a prodrug that is uncharged and this results in great corneal permeability. Experimental studies on nepafenac demonstrated enhanced permeability compared with other NSAIDs, and rapid bioactivation to amfenac by intraocular hydrolases within ocular tissues including ciliary body epithelium, retina, choroid and cornea, which results in targeted delivery of active drug to anterior and posterior segments.Furthermore, these study results have been confirmed in clinical trials. Nepafenac may have prolonged activity in vascularised tissues of the eye because bioconversion is targeted to the iris/ciliary body, and to a greater extent the retina and choroid. Nepafenac and amfenac are potent inhibitors of cyclo-oxygenase (COX) enzyme isoforms, COX-1 and COX-2. Topical nepafenac penetrated into the posterior segment in a rabbit model of concanavalin-A induced retinal inflammation, where it diminished vitreous protein and prostaglandin E 2 concentrations and reduced breakdown of the blood-retinal barrier. Other NSAIDs, including ketorolac, failed to reduce the increase of these inflammatory markers in the same study. A randomised clinical study showed that based on retinal thickening and vision, treatment with nepafenac beginning pre-surgery and used for up to 90 days post-cataract surgery is effective in preventing macular oedema and associated loss of visual acuity in diabetic patients. KeywordsNon-steroidal anti-inflammatory drugs (NSAIDs), cataract surgery, pain, inflammation, nepafenac, prodrug, permeability Disclosure: Marco Nardi has participated in the European registration study of nepafenac and has given presentations on this for which he has received honoraria. Acknowledgement:Writing support was provided by Touch Briefings.

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Topical Nonsteroidal Antiinflammatory Drugs in Ophthalmology

Cited by 105 publications

References 40 publications

Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery

Nepafenac ophthalmic suspension 0.1% for the prevention and treatment of ocular inflammation associated with cataract surgery

Dexamethasone–netilmicin: a new ophthalmic steroid–antibiotic combination. Efficacy and safety after cataract surgery

Nepafenac in the Prevention and Treatment of Ocular Inflammation and Pain Following Cataract Surgery and in the Prevention of Post-operative Macular Oedema in Diabetic Patients

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