This pilot study found that topical ketorolac may enhance the activity of intravitreal ranibizumab in reducing central macular thickness in wet AMD.
To the authors’ knowledge, this is the first open-label pilot study investigating the efficacy and safety of a combination of 0.45% ketorolac eye drops used three times a day and standard ranibizumab intravitreal injections in patients affected by CNV.
They randomized 56 patients with new-onset wet AMD to receive combination treatment with ranibizumab plus topical ketorolac or ranibizumab alone. All subjects received monthly 0.5-mg ranibizumab for three months, followed by PRN dosing. The combination group self-administered one drop of ketorolac three times a day for six months.
As six months, there was no difference between the groups in the number of injections required or in improvement in visual acuity, with both groups showing significant improvement. However, the combination group showed greater reduction in central macular thickness (−124 μm vs. −86.9 μm)
The authors did not observe any adverse events related to topical ketorolac administration, and compliance with eye drop use appeared very high. No statistically significant difference in ocular symptoms was observed between the two treatment arms.
They note that topical administration of ketorolac has many advantages over intravitreal treatment, such as better safety, lower cost and easier handling. However, some adverse effects related to topical NSAID administration, including corneal toxicity, have been reported.
They conclude that reduced disruption of retinal architecture in the combination group may preserve vision over the longer term.