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A randomised controlled trial of ranibizumab with and without ketorolac eyedrops for exudative age-related macular degeneration
  1. Andrea Russo1,
  2. Ciro Costagliola2,
  3. Luisa Delcassi1,
  4. Mario R Romano3,
  5. Francesco Semeraro1
  1. 1Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Brescia, Italy
  2. 2Department of Health Sciences, Eye Clinic, University of Molise, Campobasso, Italy
  3. 3Eye Clinic, Istituto Clinico Humanitas, Milano, Italy
  1. Correspondence to Dr Andrea Russo, Department of Neurological and Vision Sciences, Eye Clinic, University of Brescia, Piazzale Spedale Civili, 1, Brescia 25100, Italy; dott.andrea.russo{at}me.com

Abstract

Aims To evaluate whether ketorolac eyedrops and ranibizumab intravitreal injections would provide additional benefit over ranibizumab alone in the treatment of choroidal neovascularisation (CNV).

Methods This was a pilot study of eyes with new-onset CNV. A total of 56 patients were enrolled consecutively and randomised in a 1:1 ratio to receive combination treatment with intravitreal ranibizumab and topical ketorolac (group 1) or ranibizumab alone (group 2). All patients received monthly 0.5-mg ranibizumab intravitreal injections for 3 months, after which monthly injections were administered in accordance with the standard of care. Group 1 patients also self-administered one drop of ketorolac three times a day for 6 months. All patients were followed up for 6 months.

Results At 6 months, both groups showed a significant improvement in best-corrected visual acuity (both, p<0.001). The two treatments did not show significant differences in terms of the number of ranibizumab injections required. However, the mean 6-month change in central macular thickness (CMT) in the combination group was −124 µm (−29.7%; p<0.001), while in the ranibizumab-only group, the change was −86.9 µm (−19.5%; p=0.001); thus, the combination treatment resulted in a greater reduction (p=0.003). The combination treatment had no adverse effects.

Conclusions This pilot study is the first to prospectively investigate the efficacy and safety of a combination of 0.45% ketorolac eyedrops three times a day and intravitreal ranibizumab injections in patients with CNV, and suggests that topical ketorolac supplements the activity of intravitreal ranibizumab in reducing CMT in CNV.

  • Retina
  • Inflammation

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