Reduction of vitreous prostaglandin E2 Levels after topical administration of Indomethacin 0.5%, Bromfenac 0.09%, and Nepafenac 0.1%

Purpose: To assess vitreous concentrations of nonsteroidal anti-inflammatory drugs (NSAIDs) and prostaglandin E 2 (PGE 2) in patients treated with NSAIDs before vitrectomy for macular pucker. Methods: A prospective, investigator-masked, randomized study was performed in 64 patients scheduled to undergo vitrectomy. The patients were randomized 1:1:1:1 to receive indomethacin 0.5%, bromfenac 0.09%, nepafenac 0.1%, or placebo three times a day. NSAIDs and PGE 2 levels were evaluated in vitreous samples collected at the beginning of surgery. Results: Mean (SD) vitreous concentrations of the study drugs were 503.13 (241.1) pg/mL for indomethacin, 302.5 (91.03) pg/mL for bromfenac, and 284.38 (128.2) pg/mL for nepafenac. Mean (SD) vitreous PGE 2 levels were 247.9 (140.9) pg/mL for indomethacin, 322.12 (228.1) pg/mL for bromfenac, 448.8 (261.1) pg/mL for nepafenac, and 1,133 (323.9) pg/mL for placebo. All three NSAIDs reduced vitreous PGE 2 levels to a statistically significant extent, without a significant difference among them. Conclusion: All assessed NSAIDs penetrated the vitreous and lowered basal PGE 2 levels. A greater penetration was associated with pseudophakic eyes. The important inhibition of prostaglandins in the retina may have a clinical effect on the management of inflammatory retina diseases.