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    Changing the game in treatment of acute pseudophakic CME

    Bromfenac/delivery vehicle yields high intraocular concentration, more efficacious response

     

    Posterior segment 

    Though the focus of the product has been with postoperative cataract patients in regard to inflammation and prevention of ocular pain, its potential lies in the posterior segment.

    While there is not a strict/formal treatment algorithm for the treatment of Irvine-Gass CME, most retinal specialists agree that first-line therapy is a combination of a topical corticosteroid and a topical NSAID. In the majority of cases, CME resolves with this treatment regimen and other treatment modalities are utilized much less frequently (i.e., periocular/intravitreal steroids, etc.). Therefore, it becomes critical that clinicians determine which topical medications provide the best chance to resolve CME effectively.

    To date, there have been no large-scale trials comparing the different topical corticosteroids and NSAIDs in the treatment of CME. Until that day comes, ophthalmologists have to use their clinical expertise and scientific instincts to speculate on what should be the first-line treatments. In my experience, difluprednate ophthalmic emulsion 0.05% (Durezol, Alcon Laboratories) is the optimal topical corticosteroid given its potency and overall ability to provide consistent drug delivery.

    In regard to topical NSAIDs, I have been impressed with the success of bromfenac 0.075%, due to its ability to achieve a higher intraocular concentration as compared with other topical NSAIDs. The case below illustrates this point.

    Case study of B.L.

    Joshua Mali, MD
    Joshua Mali, MD, is a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, Florida.

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