Journal of Clinical and Experimental Ophthalmology
Open Access

Abstract

Incidence of Corneal Melt in Clinical Practice: Our Experience vs. A Meta-Analysis of the Literature

Michael Singer, Mario Del Cid, Jennifer Luth, Salman S Porbandarwalla, Angela Herro, Joe Pollard and Paul Woods

Purpose: To evaluate the long-term safety of NSAID drops and incidence of corneal melt including contributing factors when bromfenac, ketorolac, or nepafenac are used long-term at a dosing frequency (up to four-times daily) in patients with macular edema secondary to macular cysts, full thickness macular holes, ERM, or cystoid macular edema. A comparison of our practices safety data was compared to historically reported data to try to identify incidence rates of corneal melt as well as to identify risk factors to help predict patients at-risk.
Methods: IRB Approved retrospective review of 501 patient records, divided evenly between bromfenac, ketorolac, and nepafenac (n=167 each). Patients were on the NSAID for at least 3 months and not greater than 120 months (10 years). Data collected included the NSAID prescribed, time on the NSAID (in months), and comorbidities (focusing especially on arthritis, diabetes, dry eye, and high blood pressure).
Results: Overall, the mean duration of treatment with any NSAID was 26.1 (± 13.6) months (range: 3-120 months). Dosing was similar among the three NSAIDs, with 75.5% of patients instructed to instill the drops QID. Most patients also had at least one comorbid condition: high blood pressure and dry eye were the most common (40.9% and 33.5%, respectively). The reasons for which the NSAIDs were prescribed included macular hole (37.1%), macular cyst hole/ pseudo-hole (19.2%), ERM (30.5%) and cystoid macular edema (13.2%). There were no cases of corneal melt reported.
Conclusion: Corneal melt is an extremely rare condition that likely has a multifactorial etiology, including underlying comorbidities, use of multiple medications, and surgery. Our data suggest, however, that the newer NSAIDs are safe to use over an extended period of time and at a frequency of up to four-times daily without increased risk of corneal melt.