Session Title: Free Paper Session 6: Vitreoretinal Surgery II
Session Date/Time: Thursday 07/09/2017 | 14:30-16:00
Paper Time: 15:18
Venue: Room 111
First Author: : M.Pastore ITALY
Co Author(s): : G. Cirigliano R. D'Aloisio S. Rinaldi P. Cecchini C. De Giacinto D. Tognetto
To investigate vitreous concentrations of nonsteroidal anti-inflammatory drugs (NSAIDs) and prostaglandin E2 (PGE2) in eyes treated with NSAIDs before pars plana vitrectomy for macular pucker and macular hole, and to correlate the vitreous levels to post-surgical visual acuity improvements.
University Eye Clinic – Trieste. Prospective, investigator-masked, randomized study.
Fifty eyes of 50 consecutive patients undergoing pars plana vitrectomy for an idiopathic epiretinal membrane or macular hole were enrolled. The patients were randomized 1:1:1:1:1 to receive indomethacin 0.5%, diclofenac 0.1%, bromfenac 0.09%, nepafenac 0.3%, and placebo 3 days before and for 15 days after surgery. The postoperative NSAIDs treatment for placebo group was randomly selected. A conventional 3-port 27-gauge pars plana vitrectomy (Constellation, Vision System, Alcon, Inc, Fort-Worth-TX, USA) was performed and 0.5 to 1.0 mL of undiluted vitreous samples were collected at the beginning of surgery using the vitreous cutter positioned in the midvitreous cavity. Samples were immediately frozen at −80°C. NSAIDs vitreous concentrations were carried out using a Surveyor high-performance liquid chromatography system. PGE2 levels were analyzed using the Prostaglandin E2 Monoclonal EIA Kit (Cayman Chemical Company). Best correct visual acuity (BCVA) changes at 5, 10, 15 and 30 days from baseline were evaluated.
At baseline 36% (18/50) eyes were already pseudophakic. Mean NSAIDs vitreous concentrations were 481.9196.38 pg/mL for indomethacin 0.5%, 327.5381.15 pg/mL for bromfenac 0.09%, 312.86166.82 pg/mL for nepafenac 0.3%, 279.12230.73 pg/mL for diclofenac 0.1%. Mean vitreous PGE2 levels were 296.90184.62 pg/mL for indomethacin 0.5%, 314.12285.16 pg/mL for bromfenac 0.09%, 397.32229.06 pg/mL for nepafenac 0.3%, 431.90254.76 pg/mL for diclofenac 0.1%, and 1,274.56396.45 pg/mL for placebo group. In the different NSAIDs subgroups no significant difference in BCVA during the follow-up period were detected.
All analyzed NSAIDs penetrated the vitreous cavity and significantly reduced vitreous PGE2 levels, without a significant difference among them. Vitreous levels of NSAIDs were significantly higher in pseudophakic eyes.