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    Changing the game in treatment of acute pseudophakic CME

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

     

    Slow taper

    Subsequently, slow taper of both  bromfenac 0.075% and difluprednate was initiated. At final follow-up exam on Jan. 20, 2017 after completion of topical therapy taper, B.L’s uncorrected vision was at 20/30- OD and complete resolution of CME was achieved with no recurrence (Figure 5).

    Of note, after refraction and new glasses, B.L. was extremely happy to achieve best-corrected vision of 20/25+2 with excellent visual outcome. I postulate that bromfenac 0.075%, with its Durasite vehicle, is able to create a much higher intraocular concentration (as compared with other topical NSAIDs)—thus resulting in a more efficacious response in the treatment of acute pseudophakic CME.

    Overall, determining the best treatment agents for pseudophakic CME remains the decision of each retinal specialist. I typically implement the combination of topical bromfenac 0.075% (BromSite) (one drop twice a day) and difluprednate (one drop four times a day) with subsequent taper once resolution of CME is demonstrated.


    References

    1. http://eyewiki.aao.org/Pseudophakic_Cystoid_Macular_Edema_(Irvine-Gass_Syndrome)
    2. Irvine SR. A newly defined vitreous syndrome following cataract surgery. Am J Ophthalmol. 1953;36:599-619.
    3. Gass JDM, Norton EWD. Fluorescein studies of patients with macular edema and papilledema following cataract extraction. Trans Am Ophthalmol Soc. 1966;64:232-249.
    4. Gass JDM, Norton EWD. Cystoid macular edema and papilledema following cataract extraction. Arch Ophthalmol. 1966;76:646-661.
    5. Mali, JO Dr. Mali’s top 5 predictions in ophthalmology for 2017. December 2016. www.OphthalmologyTimes.com/Predictions2017
    6. https://www.reviewofophthalmology.com/article/thoughts-on--cataract-surg...
    7. Henderson BA, Kim JY, Ament CS, et al. Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment. J Cataract Refract Surg. 2007;33:1550-1558.
    8. Lowenstein A, Zur D. Postsurical cystoid macular edema. Dev Ophthalmol. 2010;47:148-159.
    9. Schmier JK, Halpern MT, Covert DW, Matthews GP. Evaluation of costs for cystoid macular edema among patients after cataract surgery. Retina. 2007;27:621-628.
    10. http://www.bromsite.com

     

    Joshua Mali, MD

    P: 941/923-2020

    Dr. Mali is a board-certified ophthalmologist and vitreoretinal surgeon at The Eye Associates, Sarasota, FL. Dr. Mali has no relevant financial disclosures.

    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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