Singer Daniel D, Kennedy John, Wittpenn John R
*Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; †Ophthalmic Consultants of Long Island, East Setauket, NY; and ‡State University of New York at Stony Brook, Stony Brook, NY.
Cornea. 2015 May;34(5):541-3. doi: 10.1097/ICO.0000000000000309.
Topical nonsteroidal antiinflammatory drugs (NSAIDs) are administered topically for a variety of ophthalmologic conditions. Brand diclofenac and brand ketorolac were previously shown to have topical anesthetic effects in addition to analgesic effects. Using the same method, we measured similar anesthetic effects of the 4 currently available topical NSAIDs--generic diclofenac, generic ketorolac, brand bromfenac, and brand nepafenac.
Baseline corneal sensitivity was measured on 10 healthy adult volunteers with a Cochet-Bonnet esthesiometer. One drop of the agent being studied was applied to the right eye every 5 minutes for a total of 4 drops. Corneal sensitivity was measured immediately after the last topical application and every 15 minutes for 60 minutes. After a 1-week washout period, a different agent was studied until all 4 NSAIDs were evaluated.
Corneal sensitivity profiles over time were similar for all NSAIDs. Corneal sensitivity decreased significantly from baseline immediately after topical application remaining flat from 0 to 30 minutes and then rising from 45 to 60 minutes back toward baseline in all treatment groups (P < 0.001). The maximal absolute drop in corneal sensitivity as measured by pressure thresholds was greatest for diclofenac [28.6 mm (95% confidence intervals {CI}, 19.8-37.4)], followed by ketorolac [21.1 mm (95% CI, 15.1-27.1)], bromfenac [16.9 mm (10.7-23.1)], and nepafenac [16.4 mm (95% CI, 12.7-20.1)]. Only diclofenac and nepafenac were statistically different in maximal decrease in sensitivity.
All 4 currently available NSAIDs demonstrated anesthetic effects similar to brand diclofenac and brand ketorolac.
局部用非甾体抗炎药（NSAIDs）用于多种眼科疾病的局部给药。先前已表明，品牌双氯芬酸和品牌酮咯酸除具有镇痛作用外，还具有局部麻醉作用。我们采用相同方法，测定了4种目前可用的局部用NSAIDs（通用名双氯芬酸、通用名酮咯酸、品牌溴芬酸和品牌奈帕芬酸）的类似麻醉作用。
使用Cochet-Bonnet眼压计对10名健康成年志愿者的角膜基线敏感性进行测量。每5分钟向右眼滴入1滴正在研究的药物，共滴入4滴。在最后一次局部用药后立即测量角膜敏感性，并在60分钟内每隔15分钟测量一次。经过1周的洗脱期后，研究另一种药物，直至对所有4种NSAIDs进行评估。
所有NSAIDs的角膜敏感性随时间变化的情况相似。局部用药后，角膜敏感性立即从基线显著下降，在0至30分钟保持平稳，然后在所有治疗组中从45至60分钟回升至基线（P < 0.001）。通过压力阈值测量的角膜敏感性最大绝对下降幅度，双氯芬酸最大[28.6毫米（95%置信区间{CI}，19.8 - 37.4）]，其次是酮咯酸[21.1毫米（95% CI，15.1 - 27.1）]、溴芬酸[16.9毫米（10.7 - 23.1）]和奈帕芬酸[16.4毫米（95% CI，12.7 - 20.1）]。只有双氯芬酸和奈帕芬酸在敏感性最大下降幅度上有统计学差异。
所有4种目前可用的NSAIDs均显示出与品牌双氯芬酸和品牌酮咯酸相似的麻醉作用。
