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    Changing the game in treatment of acute pseudophakic CME

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

     

    Case study

    B.L. is an 84-year-old female with history of early macular degeneration, posterior vitreous detachment, and recent uncomplicated cataract surgery in her right eye that was performed on Sept. 22, 2016. She presented with declining vision in her right eye and acute pseudophakic CME was noted on Nov. 9, 2016 with  vision of 20/40 OD (Figure 1).

    The patient was started on topical difluprednate QID and bromfenac ophthalmic solution 0.07% (Prolensa, Bausch + Lomb) QDAY as initial treatment. B.L. was re-examined on Nov. 23, 2016 and her vision had decreased to 20/60-2 OD with worsening CME on OCT (Figure 2).

    At this point, bromfenac 0.07% was increased to BID and difluprednate was continued QID. Accordingly, B.L. was seen on Dec. 8, 2016 for follow-up exam and her clinical course continued to decline further to vision of 20/100- OD and worsening CME (Figure 3).

    It was decided to trial a different topical NSAID and therefore bromfenac 0.075% (BromSite) BID was started and bromfenac 0.07% (Prolensa) was discontinued while still maintaining difluprednate QID. On follow-up examination on Dec. 22, 2016, B.L. stated her vision had incredibly returned back to normal with an uncorrected visual acuity of 20/40+ OD and dramatic reduction of her CME to nearly resolved status (Figure 4).

    Slow taper

    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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