Topical nepafenac in the treatment of diabetic macular edema

David Callanan, Patrick Williams, David Callanan, Patrick Williams

Abstract

Purpose: To determine the safety and efficacy of topical nepafenac 0.1% in the treatment of diabetic macular edema.

Methods: A consecutive case series was performed of patients treated with nepafenac monotherapy twice daily for diabetic macular edema. Visual acuities (VA) at baseline and final visit were recorded. Foveal thickness, based on optical coherence tomography, was also recorded.

Results: Six eyes of 5 patients were included in this study. Median initial Snellen vision was 20/100 (range, 20/40-20/400). After a mean of 210 days (range, 182-259), median final VA was 20/75 (range, 20/40-20/400). Four eyes gained vision and two eyes maintained vision. Mean pre-treatment vision was 0.78 logMAR and final VA was 0.67 logMAR, for a statistically significant improvement (p < 0.05). Mean initial foveal thickness was 417 microns (range, 286-599). After a mean of 178 days (range, 91-259), mean foveal thickness was 267 microns (range, 158-423), showing a statistically significant improvement (p < 0.05). Each eye had an improvement in foveal thickness.

Conclusion: The results from these 6 eyes suggest that nepafenac 0.1% may have activity against diabetic macular edema and warrants further investigation.

Keywords: NSAIDs; diabetes; diabetic macular edema; inflammation; macular edema; nepafenac.

Figures

Figure 1
Figure 1
A OCT image of left eye in Patient #3 at baseline. Central subfield thickness was 517 μm and total volume was 9.02 mm3. B OCT image of left eye in Patient #3 after 259 days of nepafenac treatment. Central subfield thickness was 158 μm and total volume was 7.35 mm3.

References

    1. [EDTRS] Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985;103:1796–806.
    1. Gibran SK, Khan K, Jungkim S, et al. Optical coherence tomographic pattern may predict visual outcome after intravitreal triamcinolone for diabetic macular edema. Ophthalmology. 2007;114:890–4.
    1. Gillies MC, Sutter FK, Simpson JM, et al. Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebo-controlled, randomized clinical trial. Ophthalmology. 2006;113:1533–8.
    1. Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 2006;26:999–1005.
    1. Kapin MA, Yanni JM, Brady MT, et al. Inflammation-mediated retinal edema in the rabbit is inhibited by topical nepafenac. Inflammation. 2003;27:281–91.
    1. Ke TL, Graff G, Spellman JM, et al. Nepafenac, a unique nonsteroidal prodrug with potential utility in the treatment of trauma-induced ocular inflammation: II. In vitro bioactivation and permeation of external ocular barriers. Inflammation. 2000;24:371–84.
    1. Kern TS, Miller CM, Du Y, et al. Topical administration of nepafenac inhibits diabetes induced retinal microvascular disease and underlying abnormalities of retinal metabolism and physiology. Diabetes. 2007;56:373–9.
    1. Meleth AD, Agron E, Chan CC, et al. Serum inflammatory markers in diabetic retinopathy. Invest Ophthalmol Vis Sci. 2005;46:4295–301.
    1. Pearson PA, Levy B. Intravitreal fluocinolone implant for diabetic macular edema: Two year results. ARVO Annual Meeting; Ft. Lauderdale, FL. May 1–5.2005.

Source: PubMed

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