Bromfenac Sodium Hydrate is Effective in Treating Intraoperative Discomfort during Selective Laser Trabeculoplasty

1

• Bromfenac Sodium Hydrate is Effective in Treating
  Intraoperative Discomfort during Selective Laser
  Trabeculoplasty
• ASCRS 2009

Lawrence F. Jindra, MD Columbia
University Winthrop University Hospital

• 1st Author has no financial disclosure
• 2nd Coauthor has no financial disclosure
• 3rd Coauthor has independently conducted and
  financed clinical research study presented and
  was a consultant to Lumenis Corporation within
  the past year

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Introduction

• Selective Laser Trabeculoplasty (SLT) uses a
  Q-Switched frequency-doubled (532 nm) NdYAG
  laser, which targets melanocytes in the
  trabecular meshwork1,2
• SLT treatment induces a biologic response in the
  trabecular meshwork, which involves the release
  of cytokines that trigger macrophage recruitment
  and other changes, leading to IOP reduction2
• SLT treats the meshwork without causing any
  thermal or coagulative damage to surrounding
  structures1,2

1. Latina MA, et al. Selective targeting of
trabecular meshwork cells in vitro studies of
pulsed and CW laser interactions. Exp Eye Res.
199560359-372. 2. Latina MA, et al. Q-switched
532-nm NdYAG laser trabeculoplasty (selective
laser trabeculoplasty) a multicenter, pilot,
clinical study. Ophthalmology. 19981052082-2090.
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Purpose and Methods

• Purpose
• To examine the effectiveness of bromfenac sodium
  hydrate 0.09 ophthalmic solution (Xibrom) in
  treating intraoperative discomfort during
  selective laser trabeculoplasty (SLT).
• Methods
• A subjective survey was performed after treatment
  of 45 eyes from February 2008 to March 2008, in a
  consecutive case series of patients who were
  treated with Xibrom during initial SLT.
• Discomfort was rated by the patient on a numeric
  scale (mild1-5severe) mean results were
  calculated and sorted by eye color (blue/brown)
  and type of treatment (primary/secondary).

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Results

• In all patients, mean discomfort was 1.7 1.0.
• Results were significant with p lt 0.01

Group Discomfort Level
All Patients 1.7 1.0
Blue Eyes 1.7 1.0
Brown Eyes 1.6 1.0
Primary Therapy 1.8 1.0
Secondary Therapy 1.7 1.3
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Discussion

• The Glaucoma Laser Trial
• Established efficacy of laser trabeculoplasty in
  lowering IOP in previously untreated glaucoma
  patients1
• The Ocular Hypertensive Treatment Study
• The Early Manifest Glaucoma Trial
• Established efficacy of early and effective
  treatment to preserve long-term visual function
  in glaucoma patients2,3
• Our findings build on these studies and suggest
  treated intraoperative discomfort during SLT was
  minimal and equivalent in blue/brown eyes and
  with primary/secondary therapy (p lt0.01)
• Further study with controlled clinical trials is
  indicated.

1. The GLT Research Group. GLT. Ophthalmology.
1990971403-1413. 2. Kass MA, et al. OHTS. Arch
Ophthalmol. 2002120701-713. 3. Heijl A, et al.
EMGT. Arch Ophthalmol. 20021201268-1279.
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Conclusion

• In this series over the long-term
• Pretreatment with Xibrom was associated with
  minimal intraoperative discomfort during SLT in
  patients with blue/brown eyes and with
  primary/secondary therapy.
• Results were significant with p lt 0.01.