Skip to main content
SpringerLink
Log in

Anterior Chamber Inflammation After Cataract Surgery: A Randomized Clinical Trial Comparing Bromfenac 0.09% to Dexamethasone 0.1%

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Purpose

To compare the efficacy of bromfenac 0.09% and dexamethasone 0.1% in the treatment of anterior chamber inflammation after uncomplicated cataract surgery.

Methods

Seventy-six patients with senile cataracts and no other ocular comorbidities who underwent uneventful phacoemulsification were randomized 1:1 to receive dexamethasone ophthalmic suspension 0.1% or bromfenac ophthalmic solution 0.09% for 2 weeks. All patients were examined on the day before surgery and postoperatively at day 1, 3, 7, 9, 11, 14 and 30. Laser flare photometry was used to quantify anterior chamber inflammation and optical coherence tomography to measure macular thickness.

Results

Bromfenac was as effective as dexamethasone in reducing inflammation in the anterior chamber of the eye. Laser flare increased the day after surgery and progressively decreased after starting the treatment with no statistically significant difference between dexamethasone and bromfenac at all time points. Visual acuity improved steadily after surgery in both groups. Mean macular thickness was similar in both the dexamethasone and bromfenac arms at 1 month.

Conclusions

Short-term therapy with topical bromfenac alone is as effective as dexamethasone in low-risk cataract surgery patients.

Trial Registration

ClinicalTrials.gov # NCT03317847; EudraCT # 2016-004358-14.

Funding

Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017;390(10094):600–12.

    Article  PubMed  Google Scholar 

  2. Shalam KV (2010-2011) Ocular pharmacotherapeutics. In: American Academy of Ophthalmology, Basic and Clinical Science Course. Fundamentals and principles of ophthalmology, p. 358.

  3. Kessel L, Tendal B, Jørgensen KJ, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology. 2014;121(10):1915–24.

    Article  PubMed  Google Scholar 

  4. Tsangaridou MA, Grzybowski A, Gundlach E, Pleyer U. Controversies in NSAIDs use in cataract surgery. Curr Pharm Des. 2015;21(32):4707–17.

    Article  CAS  PubMed  Google Scholar 

  5. Duan P, Liu Y, Li J. The comparative efficacy and safety of topical non-steroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2017;255(4):639–49.

    Article  CAS  PubMed  Google Scholar 

  6. Boscia F, Giancipoli E, D’Amico Ricci G, Pinna A. Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol. 2017;28(1):23–8.

    Article  PubMed  Google Scholar 

  7. Wielders LH, Schouten JS, Aberle MR, et al. Treatment of cystoid macular edema after cataract surgery. J Cataract Refract Surg. 2017;43(2):276–84.

    Article  PubMed  Google Scholar 

  8. Wielders LHP, Schouten JSAG, Nuijts RMMA. Prevention of macular edema after cataract surgery. Curr Opin Ophthalmol. 2018;29(1):48–53.

    Article  PubMed  Google Scholar 

  9. Lim BX, Lim CH, Lim DK, Evans JR, Bunce C, Wormald R. Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database Syst Rev. 2016;11:CD006683.

    PubMed  Google Scholar 

  10. Hoffman RS, Braga-Mele R, Donaldson K, et al. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg. 2016;42(9):1368–79.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ahmed M, Stephen Foster C. Steroid therapy for ocular inflammatory disease. Focal Points Clin Modul Ophthalmol. 2006;24(7):1–7.

    Google Scholar 

  12. Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ. Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(11):2159–68.

    Article  PubMed  Google Scholar 

  13. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–16.

    Article  PubMed  Google Scholar 

  14. Kempen JH, Ganesh SK, Sangwan VS, Rathinam SR. Interobserver agreement in grading activity and site of inflammation in eyes of patients with uveitis. Am J Ophthalmol. 2008;146(6):813.e1–818.e1.

    Google Scholar 

  15. Sawa M, Tsurimaki Y, Tsuru T, Shimizu H. New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn J Ophthalmol. 1988;32(2):132–42.

    CAS  PubMed  Google Scholar 

  16. Tugal-Tutkun I, Herbort CP. Laser flare photometry: a noninvasive, objective, and quantitative method to measure intraocular inflammation. Int Ophthalmol. 2010;30(5):453–64.

    Article  PubMed  Google Scholar 

  17. Chylack LT Jr, Wolfe JK, Singer DM, et al. The lens opacities classification system III. The longitudinal study of cataract study group. Arch Ophthalmol. 1993;111:831–6.

    Article  PubMed  Google Scholar 

  18. Donnenfeld ED, Holland EJ, Stewart RH, Gow JA, Grillone LR. Bromfenac ophthalmic solution 0.09% (Xibrom) study group. Bromfenac ophthalmic solution 0.09% (Xibrom) for postoperative ocular pain and inflammation. Ophthalmology. 2007;114:1653–62.

    Article  PubMed  Google Scholar 

  19. Coassin M, Iovieno A, Soldani A, et al. Bromfenac ophthalmic solution 0.09% as an adjunctive therapy to topical steroids after cataract surgery in pseudoexfoliation syndrome. J Cataract Refract Surg. 2016;42(8):1119–25.

    Article  PubMed  Google Scholar 

  20. Juthani VV, Clearfield E, Chuck RS. Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database Syst Rev. 2017;7:CD010516.

    PubMed  Google Scholar 

  21. Ursell PG, Spalton DJ, Whitcup SM, Nussenblatt RB. Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity. J Cataract Refract Surg. 1999;25:1492–7.

    Article  CAS  PubMed  Google Scholar 

  22. Loewenstein A, Zur D. Postsurgical cystoid macular edema. Dev Ophthalmol. 2010;47:148–59.

    Article  PubMed  Google Scholar 

  23. Flach AJ. The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc. 1998;96:557–634.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Wittpenn JR, Silverstein S, Heier J, Kenyon KR, Hunkeler JD, Earl M. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients. Am J Ophthalmol. 2008;146:554–60.

    Article  CAS  PubMed  Google Scholar 

  25. Wielders LH, Lambermont VA, Schouten JS, et al. Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis. Am J Ophthalmol. 2015;160(968–981):e33.

    Google Scholar 

  26. Wielders LHP, Schouten JSAG, Winkens B, et al. European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. J Cataract Refract Surg. 2018;44(4):429–39.

    Article  PubMed  Google Scholar 

  27. Wielders LHP, Schouten JSAG, Winkens B, et al. Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. J Cataract Refract Surg. 2018;44(7):836–47.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all patients for kindly participating in the study.

Funding

The study was sponsored by the Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy, who also funded the Rapid Service Fees.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure

Marco Coassin, Michele De Maria, Valentina Mastrofilippo, Luca Braglia, Luca Cimino, Antonio Sartori and Luigi Fontana have nothing to declare.

Compliance with Ethics Guidelines

The study protocol was approved by the local ethics committee (Comitato Etico dell’Area Vasta Emilia Nord) and the trial was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all patients.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Marco Coassin, Michele De Maria, Valentina Mastrofilippo, Antonio Sartori & Luigi Fontana

  2. Ophthalmology, University Campus Bio-Medico, Rome, Italy

    Marco Coassin

  3. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    Michele De Maria

  4. Clinical Trials and Statistics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Luca Braglia

  5. Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Luca Cimino

Authors
  1. Marco Coassin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele De Maria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentina Mastrofilippo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luca Braglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Cimino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Sartori
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Fontana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Coassin.

Additional information

Enhanced digital features

To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.9693353.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coassin, M., De Maria, M., Mastrofilippo, V. et al. Anterior Chamber Inflammation After Cataract Surgery: A Randomized Clinical Trial Comparing Bromfenac 0.09% to Dexamethasone 0.1%. Adv Ther 36, 2712–2722 (2019). https://doi.org/10.1007/s12325-019-01076-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-019-01076-4

Keywords

Search

Navigation