1. Bromfenac Sodium Hydrate is Effective in Treating Intraoperative Discomfort during Selective Laser Trabeculoplasty ASCRS 2009 Marie T. Natale Floral Park Ophthalmology Elaine M. Miglino Floral Park Ophthalmology Lawrence F. Jindra, MD Columbia University Winthrop University Hospital 1 st Author has no financial disclosure 2 nd Coauthor has no financial disclosure 3 rd Coauthor has independently conducted and financed clinical research study presented and was a consultant to Lumenis Corporation within the past year

2.  Selective Laser Trabeculoplasty (SLT) uses a Q-Switched frequency-doubled (532 nm) Nd:YAG laser, which targets melanocytes in the trabecular meshwork 1,2  SLT treatment induces a biologic response in the trabecular meshwork, which involves the release of cytokines that trigger macrophage recruitment and other changes, leading to IOP reduction 2  SLT treats the meshwork without causing any thermal or coagulative damage to surrounding structures 1,2 Introduction 1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res. 1995;60:359-372. 2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105:2082-2090.

3.  Purpose  To examine the effectiveness of bromfenac sodium hydrate 0.09% ophthalmic solution (Xibrom ® ) in treating intraoperative discomfort during selective laser trabeculoplasty (SLT).  Methods  A subjective survey was performed after treatment of 45 eyes from February 2008 to March 2008, in a consecutive case series of patients who were treated with Xibrom ® during initial SLT.  Discomfort was rated by the patient on a numeric scale (mild=1- 5=severe); mean results were calculated and sorted by eye color (blue/brown) and type of treatment (primary/secondary). Purpose and Methods

4.  In all patients, mean discomfort was 1.7 ± 1.0.  Results were significant with p < 0.01 Results GroupDiscomfort Level All Patients1.7 ± 1.0 Blue Eyes1.7 ± 1.0 Brown Eyes1.6 ± 1.0 Primary Therapy1.8 ± 1.0 Secondary Therapy1.7 ± 1.3

5.  The Glaucoma Laser Trial  Established efficacy of laser trabeculoplasty in lowering IOP in previously untreated glaucoma patients 1  The Ocular Hypertensive Treatment Study &  The Early Manifest Glaucoma Trial  Established efficacy of early and effective treatment to preserve long-term visual function in glaucoma patients 2,3  Our findings build on these studies and suggest treated intraoperative discomfort during SLT was minimal and equivalent in blue/brown eyes and with primary/secondary therapy (p <0.01)  Further study with controlled clinical trials is indicated. Discussion 1. The GLT Research Group. GLT. Ophthalmology. 1990;97:1403-1413. 2. Kass MA, et al. OHTS. Arch Ophthalmol. 2002;120:701-713. 3. Heijl A, et al. EMGT. Arch Ophthalmol. 2002;120:1268-1279.

6.  In this series over the long-term:  Pretreatment with Xibrom ® was associated with minimal intraoperative discomfort during SLT in patients with blue/brown eyes and with primary/secondary therapy.  Results were significant with p < 0.01. Conclusion