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Ocular Surface Staining Appears More Often With Bromfenac: Presented at ARVO

By Michael Casasnovas

FORT LAUDERDALE, F.L. -- May 2, 2006 -- Ocular surface toxicity associated with nonsteroidal anti-inflammatory drug treatment appeared less often when patients were administered ketorolac tromethamine rather than bromfenac in a study presented here at the Association for Research in Vision and Ophthalmology (ARVO) annual meeting.

"Ocular surface toxicity associated with ophthalmic medications is an important consideration when selecting topical preparations, especially when these agents are used postoperatively," said Y. Ralph Chu, MD, medical director, Chu Vision Institute, Edina, Minnesota.

Dr. Chu recruited 10 people with healthy eyes for his study, which was funded by a grant from Allergan, Inc. Each of the 10 right eyes received bromfenac 0.09% for 3 weeks. Each of the 10 left eyes received ketorolac tromethamine 0.4% for 3 weeks.

Corneal staining studies, using nonpreserved 2% fluorescein, were conducted at each of 4 visits. Each person received 1 drop on the lower palpebral conjunctiva, then blinked several times. A grading system for tear breakup time of 0 to 3 measured staining across 5 areas of the cornea using a yellow barrier filter and slit lamp with cobalt blue illumination.

Conjunctival staining studies were also performed at each visit, using nonpreserved 1% lissamine green. A grading system of 0 to 3 measured staining across 6 areas of the conjunctiva after 1 to 4 minutes, using a moderate white light.

"At every follow-up visit, eyes receiving bromfenac had greater amounts of conjunctival staining than eyes treated with ketorolac. These differences reached statistical significance at weeks 2 and 3," said Dr. Chu.

For example, in week 2 of the study, bromfenac showed a mean staining score of 4.5. Ketorolac showed a mean staining score of 1.9. That difference reached statistical significance at the P =.018 level, Dr. Chu said at this poster presentation April 30^th.

"The near-neutral pH of ketorolac ophthalmic solution may produce less damage to the ocular surface than the more basic bromfenac solution. It is also possible that the observed greater toxicity of bromfenac may be due to toxic properties of the molecule itself," Dr. Chu said.


[Presentation title: Clinical Evaluation of Ocular Surface Toxicity of Ketorolac Tromethamine 0.4% (Acular LS) Versus Bromfenac 0.09% (Xibrom) Ophthalmic Solution. Abstract 74]

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