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NSAIDs effective against retinal conditions, surgeon says
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LAS VEGAS — The ability of topical nonsteroidal anti-inflammatory drugs to penetrate the back of the eye and suppress retinal inflammation makes them effective potential therapies for stabilizing or improving vision in patients with a variety of retinal disorders, according to Ronald P. Gallemore, MD, PhD.
Dr. Gallemore discussed the use of NSAIDs at a continuing medical education symposium sponsored by Ista Pharmaceuticals and held during the OSN Las Vegas meeting.
He first pointed to a randomized controlled study of 546 patients with pseudophakic cystoid macular edema (CME). Researchers found that adding an NSAID to a steroidal regimen reduced the overall incidence of CME vs. steroids alone, he said.
A separate study of 85 patients with CME found that using NSAIDs alone resulted in a 12 to 16 letter gain in visual acuity, he said.
Additionally, "NSAIDs might provide an adjunctive therapy for DME (diabetic macular edema). You can put a chronic NSAID on the eyeball and stabilize the eye, and you might reduce the need for other treatments," Dr. Gallemore said.
"I consider using NSAIDs in many of my diabetics with macular edema. I use it pre- and post-laser treatment, at least for a short term, and I've been impressed with the subset of patients that it seems to help," he said.
NSAIDs may also be effective against retinal vein occlusion, a condition that is known to recur despite treatment, Dr. Gallemore said.
"It does not always work in the long run. There are patients who still recur, where the edema still comes back and you have to readjust, and you get in this vicious cycle. But in some patients, it can break the cycle and stabilize the eye, and the patients without corneal problems seem to tolerate it well and stay on this stuff for sometimes years," he said.
Patients with epiretinal membranes and DME may respond to NSAIDs, he said. One patient who did not want to undergo vitrectomy improved from 20/50 to 20/30 on a once-daily NSAID regimen, he said.
"Ninety percent of the time they still go on to have surgery, but there are definitely some patients who respond pretty well to this regimen," Dr. Gallemore said.
Another patient with postop CME improved from 20/60 to 20/20 on a 6-month once-daily NSAID regimen. Since stopping treatment, the patient has been stable at 20/25, he said.
When choosing an NSAID to use as a retinal treatment, surgeons must consider potency, penetration, patient compliance and efficacy, he said.
"The jury is still out on relative efficacies ... all these drugs seem to be beneficial in some settings," he added. Larger studies of more retinal disorders are planned, he said.