Ophthalmic utility of topical bromfenac, a twice-daily nonsteroidal anti-inflammatory agent

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the formation of prostaglandin by cyclooxygenases. Several agents in this class have been approved for the treatment of postoperative pain and inflammation following cataract surgery. Bromfenac 0.09% (Xibrom, ISTA Pharmaceuticals, USA) is a relatively new topical NSAID that exhibits ocular penetration and duration of action sufficient to permit twice-daily dosing. Bromfenac dosed twice-daily was clearly superior to placebo for postoperative pain and inflammation in a large, controlled trial and compares favorably with other NSAIDs in smaller studies. Adverse events associated with use have been minimal in large studies, although there are reports of corneal compromise with bromfenac use in cases of preexisting corneal disease. The comfort and reduced frequency of use offered by bromfenac would be expected to improve patient compliance, which would in turn be expected to result in adoption of bromfenac over other NSAIDs by many physicians. However, head-to-head trials comparing bromfenac with other NSAIDs using a twice-daily dosing schedule have not been undertaken. Bromfenac and other NSAIDs are seeing expanded use for the treatment and prevention of cystoid macular edema, and could have clinical utility in other diseases of vascular permeability.