Authors: Sara F Alharbi , Ahmed Alnabihi , Abdullah S Alqahtani

Abstract

Background: Uveitis is a major cause of visual impairment and blindness and macular edema is the major risk factor. Uveitic macular edema (UME) mechanism is primarily through blood-retinal barrier breakdown driven by inflammatory mediators such as prostaglandins and vascular endothelial growth factor (VEGF). Corticosteroids are the main treatment but can cause significant side effects leading to the use of alternatives including topical non-steroidal anti-inflammatory drugs (NSAIDs) and intravitreal anti-VEGF agents. Bromfenac is an FDA-approved NSAID for postoperative inflammation but its efficacy in UME is not clear. We report a case of UME secondary to non-infectious uveitis managed with topical bromfenac in combination with intravitreal aflibercept.

Case Presentation: A 13-year-old female with a history of chronic intermittent bilateral posterior uveitis presented for follow-up 6 months after stopping biologic treatment and 2 years of stable disease activity. Uncorrected visual acuity was 6/12 in both eyes (OU) and recurrent macular edema was found in the right eye (OD) with central foveal thickness (CFT) of 718 µm. The patient was started on bromfenac 0.09% twice daily and received a single intravitreal anti-VEGF injection. At one-week follow-up, the CFT decreased to 419 µm. At four-week follow-up, the CFT decreased to 318 µm OD and there was significant improvement of the macular edema.

Conclusion: Bromfenac 0.09% as adjunctive to anti-VEGF injection may be an effective treatment for macular edema secondary to non-infectious uveitis.

Keywords: Case report, bromfenac, macular edema, uveitis, anti-VEGF.