Effect of Topical Bromfenac In the Treatment of Central Serous Chorioretinopathy, A Study of 32 Cases

Abstract

To monitor and confirm the effect of topical bromfenac nonsteroidal anti-inflammatory drug (NSAID) in the treatment of acute central serous chorioretinopathy at our facility.

Introduction: Central serous chorioretinopathy, a disorder mostly an idiopathic ocular disorder characterized by a serous detachment of the neurosensory retina at the macula, caused by active retinal pigment epithelial leakage. Although the exact pathophysiology of CSC has not been clearly elucidated, the primary abnormality leading to RPE disruption and leakage is thought to cause increase choroidal permeability. Studies using different imaging techniques have revealed the possible causes of abnormal permeability of the inner choroid. Ischemia and inflammation might lead to exudative changes within the choroid and the subsequent changes at the RPE. Topical bromfenac, ketorolac, nepafenac and diclofenac all belong to the NSAIDs class of medications. As an anti-inflammatory class, they function by inhibiting the enzyme cyclooxygenase, which blocks the synthesis of prostaglandins. A reduction in prostaglandin formation results a decrease in inflammation. It appears that the principle pathway involved in pain and inflammation is the cycloxygenase-2 pathway where nonsteroidal anti-inflammatory drugs (NSAIDs) seems to play a significant role.

Material and Method: It is an interventional, retrospective as well as prospective study conducted at Indus Medical College Hospital, Tando Mohammad Khan from February 2017-September 2019 includes 21 patients. Only patients with acute CSC included while those with chronic or recurrence were excluded. Careful history taken about sensitivity to bromfenac or any other non-steroidal anti-inflammatory drugs NSAIDs. All 21 patients were diagnosed as having acute CSC relying upon visual acuity by standard Snellen chart, dilated fundus exam using slit lamp (SHINNIPPON SL-203, Japan) with 90D lens and OCT (ocular coherence tomography by NIDEK, model RS-330 Japan) findings. All patients were treated by bromfenac topical drops twice daily. Patients followed on 5th day, 10th day and 30th day after presentation. Vision was recorded, dilated fundoscopy and OCT performed on each visit. All 21 patients were male (Table 1), divided into 3 age groups i.e. group A(21-30yrs) includes 11(52.38%) patients, group B (31- 40 yrs.) includes 8(38.09%) patients and group C (41-50 yrs ) includes 2(9.52%) patient (Table 2). 9(42.85%) were right eyes, 12(57.14%) were left (Table 3). Vision recorded using standard Snellen chart, 11(36.52.38%) patients having vision 0.4, 5(33.33%) were 0.2, 3(14.28%) were having 0.1 while remaining 2(9.52%) were recorded as CF at 1 meter (Table 4).

Macular thickness recorded using OCT, patients again divided into 3 groups on OCT findings, group 1, 12(57.14%) patients having macular thickness between 422-485 microns, group 2, 7(33.33%) patients between 535-565 microns while group 3, includes 2(9.52.%) patients having thickness between 612-644 microns (Table 5). All 21 patients received topical bromfenac, one drop twice daily to treat acute CSC for 10 days and monitor for 1 month.

Results: This interventional study includes 21 patients who were diagnosed as acute CSC and followed from the day of presentation to 30th day. All 21 patients were undergoing intervention by using topical bromfenac eye drop, one drop twice daily for 30 days. Macular thickness and visual acuity recorded from the day of presentation up to 30th day. (Table 6) shows all changes before and after treatment and (Figure 1-4) shows early resolution of sub-macular fluid in one of these patients treated with topical bromfenac eye drops (one drop twice daily). In group 1 the macular thickness (CFT) improve from 422-485 microns at onset to 317-382 microns on 5th day becomes 246-295 on 10th day while 210-226 on 30th day. Vision improved from 0.4 to 0.7 at 5th day, improved to 0.8 on 10th day and remained same on 30th day. In group 2 the CFT reduced from 535-565 microns to 401-440 microns on 5th day becomes 318310 on 10th day and on 30th day it was 221-232 microns with improvement in visual acuity which was 0.2 at onset to 0.6 at 5th day, 0.7 at 10th day and improved to 0.8 on 30th day. In group 3 the CFT reduced from 657-722 microns to 456-469 microns on 5th day, 259-366 microns on 10th day while 206-227 microns on 30th day. Visual acuity improved from CF at onset to 0.4 on 5th day, 0.6 on 10th day and improved to 0.7 on 30th day. Conclusion: This, simple, safe, affordable and easily available treatment modality in all parts of the world with early rehabilitation of acute CSC patients.