Topical Bromfenac for Pseudophakic Cystoid Macular Edema ? Case Reports

Cystoid macular edema (CME) is the most common cause of visual loss following uncomplicated cataract surgery and although the condition usually resolves itself within several months, it can result in permanent vision loss in a minority of patients. There is a lack of consensus in diagnostic methods and definition of the condition and as a result, estimates of its incidence vary greatly, ranging from 4 to 41 %. There is also a scarcity of randomised controlled trial data to support the efficacy of ophthalmic agents in the prophylaxis and treatment of CME. However, a growing body of evidence supports the use of topical non-steroidal anti-inflammatory drugs (NSAIDs) both pre-and post-surgery. The importance of the prophylactic use of NSAIDs should be emphasized as many cases of CME are preventable. The combination of corticosteroids and NSAIDs may be more effective than either class of agents alone. The use of bromfenac for the treatment and prevention of CME is growing. Its unique chemical structure makes it highly lipophilic with rapid penetration of ocular tissues; it has sustained anti-inflammatory action and allows less frequent dosing (twice a day as opposed to three or four times a day). This article presents four case studies detailing rapid CME resolution following topical administration of bromfenac.