- A-
- A+
Inflamação
NOVEMBRO/DEZEMBRO 2010
Yoon MK, Naseri A, Porco T, McLeod SD.
Nepafenac-assisted mydriasis in a rabbit model.
J Cataract Refract Surg 2010; 36 (10): 1779-1782.
PURPOSE: To compare the effectiveness of nepafenac 0.10% in achieving and maintaining pupil dilation with the effectiveness of flurbiprofen 0.03% and a placebo in a rabbit model.
SETTING: Department of Ophthalmology, University of California, San Francisco, California, USA.
DESIGN: Laboratory study.
METHODS: Adult pigmented rabbits were randomized to 3 equal-sized groups: placebo, flurbiprofen, and nepafenac. Cataract surgery was performed in randomized order by a surgeon who was masked to group assignment. The treatment or placebo was administered starting 1 day before surgery. Phenylephrine 10.0% was administered starting 30 minutes before surgery. Phacoemulsification was performed in standard fashion. Pupil measurements were recorded before and after surgery. A linear mixed model with a random effect for the rabbits and a fixed effect for the treatment groups was used to compare mean pupil diameters between groups.
RESULTS: Baseline pupil measurements were similar between the placebo, flurbiprofen, and nepafenac groups. Preoperative pupil dilation was statistically significantly greater in the nepafenac group (mean 11.5 mm ± 0.5 [SD]) than in the placebo group (mean 10.2 ± 1.1 mm) and the flurbiprofen group (mean 9.9 ± 1.1 mm) (P<.005 and P<.001, respectively). The greater dilation was maintained at the end of surgery, at which time the nepafenac group had statistically significantly larger pupils (mean 9.4 ± 1.2 mm) than the placebo group (mean 7.9 ± 0.6 mm) and the flurbiprofen group (mean 8.5 ± 0.9 mm) (P<.001 and P<.05, respectively).
CONCLUSION: Nepafenac was more effective than a placebo and flurbiprofen in achieving maximum preoperative and postoperative pupil mydriasis in rabbits.
Pinna A.
Pseudomonas aeruginosa growth in nonsteroidal antiinflammatory solution.
J Cataract Refract Surg 2010; 36 (10): 1793-1794.
JUNHO/JULHO/AGOSTO 2010
Breusegem C, Spielberg L, Van Ginderdeuren R, Vandewalle E, Renier C, Van de Veire S, Fieuws S, Zeyen T, Stalmans I.
Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial.
Ophthalmology 2010; 117 (7): 1324-1330.
PURPOSE: To investigate the benefit of preoperative treatment with either topical nonsteroidal anti-inflammatory drug (NSAID) or steroid in terms of clinical outcomes following trabeculectomy. DE-SIGN: Prospective, randomized placebo-controlled trial. PARTICIPANTS: Sixty-one patients. ME-THODS: Between July 2005 and October 2007, 61 consecutive medically uncontrolled glaucoma pa-tients scheduled for first-time trabeculectomy were randomized to 1 of 3 study topical medication groups: nonsteroidal anti-inflammatory drugs (ketorolac), steroids (fluorometholone), or placebo (arti-ficial tears). Patients instilled 1 drop 4 times daily for 1 month before the procedure and were exami-ned on days 1 and 2, at weeks 1, 2, and 4, and at months 3, 6, 12, 18, and 24 after trabeculectomy. MAIN OUTCOME MEASURES: Incidence of postoperative surgical or medical interventions (nee-dling, laser suture lysis, needling revision, and intraocular pressure [IOP]-lowering medication). RE-SULTS: Fifty-four patients (54 eyes) were entered for analysis. The mean number of preoperative me-dications was 2.3+/-0.9. The mean baseline IOP was 21.0+/-6.0 mmHg. The mean postoperative target IOP was 16.5+/-1.8 mmHg. The mean follow-up was 23.6+/-4.0 months. The percentage of patients requiring needling within the first year was 41% in the placebo group, 6% in the NSAID, and 5% in the steroid group (P = 0.006). The percentage of patients requiring IOP-lowering medication to reach the target IOP at 1 year was 24% in the placebo group, 18% in the NSAID group, and 0% in the ste-roid group (P = 0.054 overall; P = 0.038 for steroids vs. others). The log-rank test showed a significant (P = 0.019) difference in medication-free survival curves between the different groups. More specifi-cally, patients in the steroid group needed significantly less medication over the total follow-up (P = 0.007). CONCLUSIONS: Topical ketorolac or fluorometholone for 1 month before surgery was asso-ciated with improved trabeculectomy outcomes in terms of likelihood of postoperative needling. In the steroid group, there was a significantly reduced need for additional postoperative IOP-lowering medi-cation compared with the other groups. FINANCIAL DISCLOSURE(S): The author(s) have no pro-prietary or commercial interest in any materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Masuda I, Matsuo T, Okamoto K, Matsushita K, Ohtsuki H.
Two cases of corneal perforation after oral administration of nonsteroidal anti-inflammatory drugs: oral NSAID-induced corneal damage.
Eur J Ophthalmol 2010; 20 (2): 454-456.
PURPOSE: To report 2 cases of corneal perforation associated with the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS: In a 62-year-old woman and a 79-year-old woman, corneal perforation occurred after 7 days and 5 months of oral NSAIDs administration, respectively. RESULTS: After NSAIDs were discontinued, the cornea epithelialized and the anterior chamber formed within 14 and 10 days, respectively. CONCLUSIONS: It is well known that topical NSAIDs cause corneal perforation. Observations in the present cases suggest that the oral administration of NSAIDs may also cause corneal damage, and hence, medical professionals should consider the risk of damage to the cornea when administering these drugs orally.
Maca SM, Amon M, Findl O, Kahraman G, Barisani-Asenbauer T.
Efficacy and tolerability of preservative-free and preserved diclofenac and preserved ketorolac eyedrops after cataract surgery.
Am J Ophthalmol 2010; 149 (5): 777-784.
PURPOSE: To compare the anti-inflammatory efficacy and subjective tolerability of preservative-free and preserved diclofenac 0.1% and preserved ketorolac 0.5% eye drops for prophylaxis and management of inflammation after cataract surgery. DESIGN: Prospective, randomized, investigator-masked, parallel-group, comparative clinical trial. METHODS: One hundred two patients who underwent small-incision phacoemulsification cataract surgery in an institutional setting were assigned randomly to receive preservative-free diclofenac sodium 0.1% (Voltaren ophtha SDU; Novartis Pharma), preserved diclofenac sodium 0.1% (Voltaren ophtha; Novartis Pharma), or preserved ketorolac tromethamine 0.5% (Acular; Pharm Allergan) eyedrops 4 times daily for 4 weeks after surgery. During the 1-month follow-up, anterior chamber flare and mean foveal thickness were evaluated for objective comparison of the anti-inflammatory effect. Ocular tolerability was assessed by observer-based grading of conjunctival hyperemia and ocular discomfort, as well as obtaining subjective ratings of ocular tolerability on a visual analog scale. Distance and near visual acuity and intraocular pressure served as safety measures. RESULTS: All 3 formulations demonstrated equal anti-inflammatory efficacy as measured by reduction of anterior chamber flare after surgery and prevention of postoperative macular edema. Patients treated with preservative-free diclofenac eyedrops reported significantly better subjective tolerability values (P = .001), were classified as having less ocular discomfort (P < .001), and experienced earlier reduction of postoperative conjunctival hyperemia (P = .029). CONCLUSIONS: Anti-inflammatory efficacy was comparable for all 3 agents. However, preservative-free diclofenac 0.1% eyedrops exhibited a significantly better postoperative subjective and objective tolerability when compared with preserved eyedrops containing ketorolac or diclofenac. Copyright 2010 Elsevier Inc. All rights reserved.
ABRIL/MAIO 2010
Soheilian M, Karimi S, Ramezani A, Peyman GA.
Pilot study of intravitreal injection of diclofenac for treatment of macular edema of various etio-logies.
Retina 2010; 30 (3): 509-15.
Abstract
PURPOSE: The purpose of this study was to evaluate the effect of a single dose of intravitreal diclofenac, a potent nonsteroidal antiinflammatory drug, on visual acuity and central macular thickness in patients with macular edema of various etiologies. METHODS: In this prospective noncomparative case series, 10 eyes of 10 patients with clinically significant diabetic macular edema (n = 5), neovascular age-related macular degeneration (n = 2), pseudophakic cystoid macular edema (n = 1), macular edema secondary to old branch retinal vein occlusion (n = 1), and cystoid macular edema secondary to chronic intermediate uveitis (n = 1) received 500 microg/0.1 mL of intravitreal diclofenac. The primary outcome measure was change in visual acuity. RESULTS: After 2 weeks, visual acuity improved in 3 (30%) eyes (P = 0.78), did not change in 3 (30%) eyes, and decreased in 3 (30%) eyes. After 4 weeks, improvement of best-corrected visual acuity occurred in 5 (50%) eyes (P = 0.07), but in 3 eyes (30%), best-corrected visual acuity did not change, and in 1 eye (10%), visual acuity decreased. After 8 weeks, visual acuity improved in 7 (70%) eyes (P = 0.019), got worse in 1 eye (10%), and did not change in 2 eyes (20%). Central macular thickness did not decrease significantly at 8 weeks. On the basis of electroretinography, no significant changes in the amplitude of a-wave or b-wave in relation to baseline were noticed in any eye. CONCLUSION: Up to 8 weeks, intravitreal diclofenac treatment of eyes with macular edema of various etiologies yielded prominent improvement in visual acuity but was not associated with a significant decrease in central macular thickness. No toxic effect of intravitreal diclofenac was observed.
MARÇO 2010
Law SK, Kim E, Yu F, Caprioli J.
Clinical cystoid macular edema after cataract surgery in glaucoma patients.
J Glaucoma 2010; 19 (2): 100-104.
PURPOSE: To determine the prevalence of and risk factors for developing clinical cystoid macular edema (CME) after cataract surgery in patients with glaucoma. PATIENTS AND METHODS: Medi-cal records of patients who had cataract surgery between April 1998 and July 2006 without prior his-tory of CME, a known risk factor to develop CME, or previous nonglaucoma ocular laser procedures or intraocular surgeries were reviewed. Clinical CME was diagnosed by fundus examination within 3 months postoperatively and confirmed with fluorescein angiography or optical coherence tomography. Outcome measures included prevalence of clinical CME by comparing patients with and without glau-coma; and risk factor analysis for clinical CME by comparing patients who did and did not develop CME after cataract surgery. RESULTS: Seven hundred patients (eyes) with glaucoma and 553 patients (eyes) without glaucoma were included. The prevalences of clinical CME in glaucoma and nonglau-coma patients were 5.14% and 5.79%, respectively (P=0.618). Patients who developed clinical CME (68 patients) had statistically higher rates of posterior capsule rupture or required anterior vitrectomy during surgery (P=0.010, odds ratio=3.35, 95% CI 1.33-8.45) compared with patients who did not develop clinical CME (1185 patients). No glaucoma medications used either preoperatively or postoperatively were associated with clinical CME (P>0.05). CONCLUSIONS: Rupture of posterior capsule and anterior vitrectomy during cataract surgery is a potential risk factor for developing clinical CME after cataract surgery. There is no statistically significant difference in the prevalence of clinical CME after small corneal incision phacoemulsification cataract surgery between glaucoma and nonglaucoma patients.
FEVEREIRO 2010
Gueudry J, Lebel H, Muraine M.
Severe corneal complications associated with topical indomethacin use.
Br J Ophthalmol 2010; 94 (1): 133.
Warren KA, Bahrani H, Fox JE.
NSAIDs in combination therapy for the treatment of chronic pseudophakic cystoid macular edema.
Retina 2010; 30 (2): 260-266.
PURPOSE: The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflam-matory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injec-tions for the treatment of chronic cystoid macular edema. METHODS: Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ke-torolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks. RESULTS: At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thick-ness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy. CONCLUSION: Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.
Mathys KC, Cohen KL.
Impact of nepafenac 0.1% on macular thickness and postoperative visual acuity after cataract surgery in patients at low risk for cystoid macular oedema.
Eye (Lond) 2010; 24 (1): 90-96.
PURPOSE: To evaluate the use of topical nepafenac 0.1% after routine phacoemulsification in patients at low risk for cystoid macular oedema (CME) using optical coherence tomography (OCT) measure-ment of macular thickness. METHODS: Seventy-nine subjects with no risk factors for CME had un-complicated bimanual micro-incision cataract surgery by an experienced surgeon. All subjects received preoperative nepafenac. Subjects were randomised to postoperative standard of care, consisting of a topical antibiotic for 10 days and topical corticosteroid for 1 month (control), or standard of care plus nepafenac for 1 month (treatment). OCT and ETDRS best-corrected visual acuity were measured preoperatively and 2 months postoperatively. Primary endpoints were comparison of changes in macu-lar thickness between groups and the relationship of that change to postoperative vision. RESULTS: All subjects had excellent visual outcomes, with mean visual improvement of 15 letters. Cataract sur-gery was very efficient with a mean effective phaco time (EPT) of 4.99 and 6.90 s in the control and treatment groups, respectively. There were small increases in the central macular thickness in both the control (2.78 microm) and treatment (5.60 microm) groups. The change in macular thickness was sta-tistically similar between groups and did not correlate with the final visual outcome. DISCUSSION: The small increase in macular thickness after routine cataract surgery is probably not clinically signifi-cant. In subjects undergoing routine cataract surgery, and at low risk for CME, the routine use of pre-operative nepafenac may be all that is necessary to achieve excellent visual recovery.
