Advances in Therapy

, Volume 36, Issue 10, pp 2712–2722 | Cite as

Anterior Chamber Inflammation After Cataract Surgery: A Randomized Clinical Trial Comparing Bromfenac 0.09% to Dexamethasone 0.1%

  • Marco CoassinEmail author
  • Michele De Maria
  • Valentina Mastrofilippo
  • Luca Braglia
  • Luca Cimino
  • Antonio Sartori
  • Luigi Fontana
Original Research



To compare the efficacy of bromfenac 0.09% and dexamethasone 0.1% in the treatment of anterior chamber inflammation after uncomplicated cataract surgery.


Seventy-six patients with senile cataracts and no other ocular comorbidities who underwent uneventful phacoemulsification were randomized 1:1 to receive dexamethasone ophthalmic suspension 0.1% or bromfenac ophthalmic solution 0.09% for 2 weeks. All patients were examined on the day before surgery and postoperatively at day 1, 3, 7, 9, 11, 14 and 30. Laser flare photometry was used to quantify anterior chamber inflammation and optical coherence tomography to measure macular thickness.


Bromfenac was as effective as dexamethasone in reducing inflammation in the anterior chamber of the eye. Laser flare increased the day after surgery and progressively decreased after starting the treatment with no statistically significant difference between dexamethasone and bromfenac at all time points. Visual acuity improved steadily after surgery in both groups. Mean macular thickness was similar in both the dexamethasone and bromfenac arms at 1 month.


Short-term therapy with topical bromfenac alone is as effective as dexamethasone in low-risk cataract surgery patients.

Trial Registration # NCT03317847; EudraCT # 2016-004358-14.


Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy.


Cataract surgery Laser flare photometry Non-steroidal anti-inflammatory drugs Ophthalmology 



The authors thank all patients for kindly participating in the study.


The study was sponsored by the Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy, who also funded the Rapid Service Fees.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Marco Coassin, Michele De Maria, Valentina Mastrofilippo, Luca Braglia, Luca Cimino, Antonio Sartori and Luigi Fontana have nothing to declare.

Compliance with Ethics Guidelines

The study protocol was approved by the local ethics committee (Comitato Etico dell’Area Vasta Emilia Nord) and the trial was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all patients.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. 1.
    Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017;390(10094):600–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Shalam KV (2010-2011) Ocular pharmacotherapeutics. In: American Academy of Ophthalmology, Basic and Clinical Science Course. Fundamentals and principles of ophthalmology, p. 358.Google Scholar
  3. 3.
    Kessel L, Tendal B, Jørgensen KJ, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology. 2014;121(10):1915–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Tsangaridou MA, Grzybowski A, Gundlach E, Pleyer U. Controversies in NSAIDs use in cataract surgery. Curr Pharm Des. 2015;21(32):4707–17.CrossRefPubMedGoogle Scholar
  5. 5.
    Duan P, Liu Y, Li J. The comparative efficacy and safety of topical non-steroidal anti-inflammatory drugs for the treatment of anterior chamber inflammation after cataract surgery: a systematic review and network meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2017;255(4):639–49.CrossRefPubMedGoogle Scholar
  6. 6.
    Boscia F, Giancipoli E, D’Amico Ricci G, Pinna A. Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol. 2017;28(1):23–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Wielders LH, Schouten JS, Aberle MR, et al. Treatment of cystoid macular edema after cataract surgery. J Cataract Refract Surg. 2017;43(2):276–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Wielders LHP, Schouten JSAG, Nuijts RMMA. Prevention of macular edema after cataract surgery. Curr Opin Ophthalmol. 2018;29(1):48–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Lim BX, Lim CH, Lim DK, Evans JR, Bunce C, Wormald R. Prophylactic non-steroidal anti-inflammatory drugs for the prevention of macular oedema after cataract surgery. Cochrane Database Syst Rev. 2016;11:CD006683.PubMedGoogle Scholar
  10. 10.
    Hoffman RS, Braga-Mele R, Donaldson K, et al. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg. 2016;42(9):1368–79.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ahmed M, Stephen Foster C. Steroid therapy for ocular inflammatory disease. Focal Points Clin Modul Ophthalmol. 2006;24(7):1–7.Google Scholar
  12. 12.
    Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ. Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122(11):2159–68.CrossRefPubMedGoogle Scholar
  13. 13.
    Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Kempen JH, Ganesh SK, Sangwan VS, Rathinam SR. Interobserver agreement in grading activity and site of inflammation in eyes of patients with uveitis. Am J Ophthalmol. 2008;146(6):813.e1–818.e1.Google Scholar
  15. 15.
    Sawa M, Tsurimaki Y, Tsuru T, Shimizu H. New quantitative method to determine protein concentration and cell number in aqueous in vivo. Jpn J Ophthalmol. 1988;32(2):132–42.PubMedGoogle Scholar
  16. 16.
    Tugal-Tutkun I, Herbort CP. Laser flare photometry: a noninvasive, objective, and quantitative method to measure intraocular inflammation. Int Ophthalmol. 2010;30(5):453–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Chylack LT Jr, Wolfe JK, Singer DM, et al. The lens opacities classification system III. The longitudinal study of cataract study group. Arch Ophthalmol. 1993;111:831–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Donnenfeld ED, Holland EJ, Stewart RH, Gow JA, Grillone LR. Bromfenac ophthalmic solution 0.09% (Xibrom) study group. Bromfenac ophthalmic solution 0.09% (Xibrom) for postoperative ocular pain and inflammation. Ophthalmology. 2007;114:1653–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Coassin M, Iovieno A, Soldani A, et al. Bromfenac ophthalmic solution 0.09% as an adjunctive therapy to topical steroids after cataract surgery in pseudoexfoliation syndrome. J Cataract Refract Surg. 2016;42(8):1119–25.CrossRefPubMedGoogle Scholar
  20. 20.
    Juthani VV, Clearfield E, Chuck RS. Non-steroidal anti-inflammatory drugs versus corticosteroids for controlling inflammation after uncomplicated cataract surgery. Cochrane Database Syst Rev. 2017;7:CD010516.PubMedGoogle Scholar
  21. 21.
    Ursell PG, Spalton DJ, Whitcup SM, Nussenblatt RB. Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity. J Cataract Refract Surg. 1999;25:1492–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Loewenstein A, Zur D. Postsurgical cystoid macular edema. Dev Ophthalmol. 2010;47:148–59.CrossRefPubMedGoogle Scholar
  23. 23.
    Flach AJ. The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc. 1998;96:557–634.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Wittpenn JR, Silverstein S, Heier J, Kenyon KR, Hunkeler JD, Earl M. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs steroid alone in low-risk cataract surgery patients. Am J Ophthalmol. 2008;146:554–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Wielders LH, Lambermont VA, Schouten JS, et al. Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis. Am J Ophthalmol. 2015;160(968–981):e33.Google Scholar
  26. 26.
    Wielders LHP, Schouten JSAG, Winkens B, et al. European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1. J Cataract Refract Surg. 2018;44(4):429–39.CrossRefPubMedGoogle Scholar
  27. 27.
    Wielders LHP, Schouten JSAG, Winkens B, et al. Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. J Cataract Refract Surg. 2018;44(7):836–47.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Ophthalmology UnitAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
  2. 2.Ophthalmology, University Campus Bio-MedicoRomeItaly
  3. 3.Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Clinical Trials and Statistics UnitAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
  5. 5.Ocular Immunology UnitAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly

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