1. Efficacy of Bromfenac 0.09% in Prevention and Treatment of Pseudophakic CME When Used Preoperatively and Postoperatively by Melissa M. Cable, MD, FAAO, FACS Discover Vision Centers *Author has relationships with the following companies with or without honoraria: Allergan, Alcon, B&L, Ista, Inspire, Ocular Therapeutix

2. ASCRS 2010 Purpose To evaluate the efficacy of a topical ophthalmic non- steroidal anti-inflammatory in preventing symptomatic pseudophakic cystoid macular edema in the initial three months following phacoemulsification surgery when dosed pre and post-operatively.

3. ASCRS 2010 Methods Retrospective review of 1020 charts of all patients who had uneventful phacoemulsification and intraocular lens placement by one surgeon over a 30 month time period. Patients were instructed to use bromfenac 0.09% (ISTA Pharmaceuticals) twice daily beginning three days prior to surgery and twice daily until gone after surgery.

4. ASCRS 2010 Methods Patients were evaluated with Snellen visual acuity chart at one day, one week, six weeks, and for any interim visits. Patients underwent dilated fundus exam with 90 diopter lens at one week. Patients with decreased vision and/or suggestive fundus findings were referred for macular OCT and/or fluorescein angiography.

5. ASCRS 2010 Results Five eyes of three patients of 1020 cases (0.5%) were confirmed to have pseudophakic cystoid macular edema by OCT and in two cases, additional confirmation by flourescein angiography was obtained. In this group one patient had documented pre-existing epiretinal membrane.

6. ASCRS 2010 Results The mean onset of pseudophakic cystoid macular edema was five weeks with a mean visual acuity at that time of logmar -0.416 (app. 20/50). Mean time to resolution after onset of pseudophakic cystoid edema was 7.6 weeks and resolution was confirmed by OCT.

7. ASCRS 2010 Results Mean age of patients diagnosed was 66 years of age. Final best corrected visual acuity was logmar -0.15 (20/30). There were no adverse ocular or systemic events.

8. ASCRS 2010 Conclusion Bromfenac 0.09% used bid three days prior to phacoemulsification and lens implantation and bid until gone after surgery appears to be highly effective in preventing pseudophakic cystoid macular edema.

9. ASCRS 2010 Conclusion In this study, two patients without systemic or ocular risk factors experienced pseudophakic CME. Treatment of pseudophakic CME with bromfenac 0.09% appears to be an effective way to reduce the signs of CME by OCT and improve visual acuity.

10. ASCRS 2010 About the Author Melissa M. Cable, MD, FAAO, FACS, is a board-certified ophthalmologist with Discover Vision Centers in Kansas City, MO., specializing in gentle no-stitch cataract surgery, ocular disease and cosmetic procedures. Dr. Cable graduated at the top 5% of her class in both her undergraduate and medical degree programs at Louisiana State University. She completed a residency in ophthalmology at the University of Missouri—Kansas City before joining Discover Vision Centers in 1999. Dr. Cable is one of only six partners in the company. With 35 doctors, 9 locations and 3 surgery centers located in the Kansas City Metro area, Discover Vision Centers has become one of the largest private ophthalmic medical-surgical practices in the United States.

11. ASCRS 2010 Thank you! Contact Information: Melissa M. Cable, MD, FAAO, FACS Partner – Discover Vision Centers, Kansas City Phone: 816.478.1230 Fax: 816.478.4413 E-mail: mcable@discovervision.commcable@discovervision.com www.discovervision.com