Skip to main content
Top
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 12/2017

01-12-2017 | Basic Science

Pharmacokinetics and efficacy of intraocular flurbiprofen

Authors: S. Blazaki, C. Tsika, M. Tzatzarakis, E. Naoumidi, A. Tsatsakis, C. Tsatsanis, Miltiadis K. Tsilimbaris

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 12/2017

Login to get access

Abstract

Purpose

Intravitreal delivery of non-steroidal anti-inflammatory drugs could be an effective way to treat macular edema caused by posterior segment inflammation. In this study, we evaluated the intravitreal bioavailability and anti-inflammatory efficacy of flurbiprofen in rabbit eyes.

Methods

For pharmacokinetics, 0.1 ml of 7.66 mg/ml flurbiprofen solution was injected intravitreally and vitreous drug levels were analyzed at specific time points using LC-MS technique. For efficacy, 100 ng lipopolysaccharide of E.coli was injected intravitreally in rabbits to induce inflammation. The animals were separated in three groups and received intraocular flurbiprofen, dexamethasone and PBS to serve as control. Complete ocular examination and total cell count in aqueous fluid were determined to evaluate the extent of inflammation. Eyes were then enucleated for histopathology analysis. The efficacy in the uveitis model was determined by clinical signs of inflammation, total leukocyte count and histology findings.

Results

No adverse events were observed during pharmacokinetic assessment. No signs of inflammation, hemorrhage or retina detachment were detected. The recovery of flurbiprofen from vitreous samples was 92.6%. The half-life of flurbiprofen was estimated to be 1.92 h with an elimination constant rate (K) of 0.36. Treatment with intraocular injections of flurbiprofen and dexamethasone significantly reduced total leukocyte count in a manner comparable to dexamethasone [reduction of 96.84% (p < 0.05) and 97.44% (p < 0.05), respectively]. Histologic studies demonstrated significantly less signs of ocular inflammation after flurbiprofen injection compared to control eyes.

Conclusions

Flurbiprofen is effective in suppressing inflammation in this experimental uveitis model. In our experimental setting, intravitreal flurbiprofen seem to have a therapeutic result comparable to dexamethasone. However, the half-life of the drug remains short, necessitating further research to prolong its presence in the vitreous cavity.
Literature
1.
go back to reference Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ (2015) Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the American Academy of ophthalmology. Ophthalmology 122(11):2159–2168CrossRefPubMed Kim SJ, Schoenberger SD, Thorne JE, Ehlers JP, Yeh S, Bakri SJ (2015) Topical nonsteroidal anti-inflammatory drugs and cataract surgery: a report by the American Academy of ophthalmology. Ophthalmology 122(11):2159–2168CrossRefPubMed
2.
go back to reference Gillies MC, Kuzniarz M, Craig J, Ball M, Luo W, Simpson JM (2005) Intravitreal triamcinolone-induced elevated intraocular pressure is associated with the development of posterior subcapsular cataract. Ophthalmology 112(1):139–143CrossRefPubMed Gillies MC, Kuzniarz M, Craig J, Ball M, Luo W, Simpson JM (2005) Intravitreal triamcinolone-induced elevated intraocular pressure is associated with the development of posterior subcapsular cataract. Ophthalmology 112(1):139–143CrossRefPubMed
3.
go back to reference Roth DB, Verma V, Realini T, Prenner JL, Feuer WJ, Fechtner RD (2009) Long-term incidence and timing of intraocular hypertension after intravitreal triamcinolone acetonide injection. Ophthalmology 116(3):455–460CrossRefPubMed Roth DB, Verma V, Realini T, Prenner JL, Feuer WJ, Fechtner RD (2009) Long-term incidence and timing of intraocular hypertension after intravitreal triamcinolone acetonide injection. Ophthalmology 116(3):455–460CrossRefPubMed
4.
go back to reference Abdel-Aziz AA, Al-Badr AA, Hafez GA (2012) Flurbiprofen. Profiles Drug Subst Excip Relat Methodol 37:113–181CrossRefPubMed Abdel-Aziz AA, Al-Badr AA, Hafez GA (2012) Flurbiprofen. Profiles Drug Subst Excip Relat Methodol 37:113–181CrossRefPubMed
5.
go back to reference Morales AM, Kivilcim M, Peyman GA, Main M, Manzano RP (2009) Intravitreal toxicity of ketorolac tris salt and flurbiprofen. Ophthalmic Surg Lasers Imaging 40(1):38–42CrossRefPubMed Morales AM, Kivilcim M, Peyman GA, Main M, Manzano RP (2009) Intravitreal toxicity of ketorolac tris salt and flurbiprofen. Ophthalmic Surg Lasers Imaging 40(1):38–42CrossRefPubMed
7.
go back to reference Hye IL, Chang IC, Ji YB, Jung EL, So YP, Young HK, Se HK, Yun JL, Choon GJ, Seok YL (2014) Simultaneous determination of flurbiprofen and its hydroxy metabolite in human plasma by liquid chromatography-tandem mass spectrometry for clinical application. J Chromatogr B 971:58–63CrossRef Hye IL, Chang IC, Ji YB, Jung EL, So YP, Young HK, Se HK, Yun JL, Choon GJ, Seok YL (2014) Simultaneous determination of flurbiprofen and its hydroxy metabolite in human plasma by liquid chromatography-tandem mass spectrometry for clinical application. J Chromatogr B 971:58–63CrossRef
8.
go back to reference Bakri SJ, Snyder MMR, Reid JM, Pulido JS (2007) Pharmacokinetics of intravitreal bevacizumab (avastin). Ophthalmol 114:855–859CrossRef Bakri SJ, Snyder MMR, Reid JM, Pulido JS (2007) Pharmacokinetics of intravitreal bevacizumab (avastin). Ophthalmol 114:855–859CrossRef
9.
go back to reference Goldblum D, Fausch K, Frueh BE, Theurillat R, Thormann W, Zimmerli S (2007) Ocular penetration of caspofungin in a rabbit uveitis model. Graefes Arch Clin Exp Ophthalmol 245(6):825–833CrossRefPubMed Goldblum D, Fausch K, Frueh BE, Theurillat R, Thormann W, Zimmerli S (2007) Ocular penetration of caspofungin in a rabbit uveitis model. Graefes Arch Clin Exp Ophthalmol 245(6):825–833CrossRefPubMed
10.
go back to reference Serif N, Gurelik G, Hasanreisoğlu M, Yaman H, Akyurek N (2016) Evaluation of Neopterin levels in an Endotoxin-induced experimental Uveitis model. Semin Ophthalmol 31(3):256–260PubMed Serif N, Gurelik G, Hasanreisoğlu M, Yaman H, Akyurek N (2016) Evaluation of Neopterin levels in an Endotoxin-induced experimental Uveitis model. Semin Ophthalmol 31(3):256–260PubMed
11.
go back to reference Kim SJ, Toma H, Shah R, Kompella UB, Vooturi SK, Sheng J (2014) The safety, pharmacokinetics, and efficacy of intraocular celecoxib. Invest Ophthalmol Vis Sci 55(3):1409–1418CrossRefPubMedPubMedCentral Kim SJ, Toma H, Shah R, Kompella UB, Vooturi SK, Sheng J (2014) The safety, pharmacokinetics, and efficacy of intraocular celecoxib. Invest Ophthalmol Vis Sci 55(3):1409–1418CrossRefPubMedPubMedCentral
12.
go back to reference Kim SJ, Doherty TJ, Cherney EF (2012) Intravitreal ketorolac for chronic uveitis and macular edema: a pilot study. Arch Ophthalmol 130(4):456–460CrossRefPubMed Kim SJ, Doherty TJ, Cherney EF (2012) Intravitreal ketorolac for chronic uveitis and macular edema: a pilot study. Arch Ophthalmol 130(4):456–460CrossRefPubMed
13.
go back to reference Ramezani A, FardEsmaeilpour N, Eskandari A, Rabbanikhah Z, Soheilian R, Soheilian M (2013) Intravitreal diclofenac for refractory uveitic cystoid macular edema. J Ophthalmic Vis Res 8(1):47–52PubMedPubMedCentral Ramezani A, FardEsmaeilpour N, Eskandari A, Rabbanikhah Z, Soheilian R, Soheilian M (2013) Intravitreal diclofenac for refractory uveitic cystoid macular edema. J Ophthalmic Vis Res 8(1):47–52PubMedPubMedCentral
14.
go back to reference Maldonado RM, Vianna RN, Cardoso GP, de Magalhaes AV, Burnier MN (2011) Intravitreal injection of commercially available ketorolac tromethamine in eyes with diabetic macular edema refractory to laser photocoagulation. Curr Eye Res 36(8):768–773CrossRefPubMed Maldonado RM, Vianna RN, Cardoso GP, de Magalhaes AV, Burnier MN (2011) Intravitreal injection of commercially available ketorolac tromethamine in eyes with diabetic macular edema refractory to laser photocoagulation. Curr Eye Res 36(8):768–773CrossRefPubMed
15.
go back to reference Reis Ado C, Vianna RN, Reis RS, Cardoso GP (2010) Intravitreal injection of ketorolac tromethamine in patients with diabetic macular edema refractory to retinal photocoagulation. Arq Bras Oftalmol 73(4):338–342CrossRefPubMed Reis Ado C, Vianna RN, Reis RS, Cardoso GP (2010) Intravitreal injection of ketorolac tromethamine in patients with diabetic macular edema refractory to retinal photocoagulation. Arq Bras Oftalmol 73(4):338–342CrossRefPubMed
16.
go back to reference Kim SJ, Toma HS (2010) Inhibition of choroidal neovascularization by intravitreal ketorolac. Arch Ophthalmol 128(5):596–600CrossRefPubMed Kim SJ, Toma HS (2010) Inhibition of choroidal neovascularization by intravitreal ketorolac. Arch Ophthalmol 128(5):596–600CrossRefPubMed
17.
go back to reference Tsilimbaris MK, Tsika C, Kymionis GD (2016) Intravitreal ketorolac for the treatment of chronic cystoid macular edema after cataract surgery. TherClin Risk Manag 12(12):177–182 Tsilimbaris MK, Tsika C, Kymionis GD (2016) Intravitreal ketorolac for the treatment of chronic cystoid macular edema after cataract surgery. TherClin Risk Manag 12(12):177–182
18.
go back to reference Schoenberger SD, Kim SJ, Sheng J, Rezaei KA, Lalezary M, Cherney E (2012) Increased prostaglandin E2 (PGE2) levels in proliferative diabetic retinopathy, and correlation with VEGF and inflammatory cytokines. Invest Ophthalmol Vis Sci 53:5906–5911CrossRefPubMed Schoenberger SD, Kim SJ, Sheng J, Rezaei KA, Lalezary M, Cherney E (2012) Increased prostaglandin E2 (PGE2) levels in proliferative diabetic retinopathy, and correlation with VEGF and inflammatory cytokines. Invest Ophthalmol Vis Sci 53:5906–5911CrossRefPubMed
19.
go back to reference Sabiston DW, Robinson IG (1987) An evaluation of the anti-inflammatory effect of flurbiprofen after cataract extraction. Br L Ophthalmol 71(6):418–421CrossRef Sabiston DW, Robinson IG (1987) An evaluation of the anti-inflammatory effect of flurbiprofen after cataract extraction. Br L Ophthalmol 71(6):418–421CrossRef
20.
go back to reference Diakonis VF, Tsourdou A, Tzatzarakis MN, Tsika C, Charisis S, Naoumidi I, Plainis S, Tsilimbaris MK (2013) Evaluation of vitreous clearance and potential retinal toxicity of intravitreal lornoxicam (xefo). J OculPharmacolTher 29(7):627–632 Diakonis VF, Tsourdou A, Tzatzarakis MN, Tsika C, Charisis S, Naoumidi I, Plainis S, Tsilimbaris MK (2013) Evaluation of vitreous clearance and potential retinal toxicity of intravitreal lornoxicam (xefo). J OculPharmacolTher 29(7):627–632
21.
go back to reference Gan IM, Ugahary LC, van Dissel JT, van Meurs JC (2005) Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 243:1186–1189CrossRefPubMed Gan IM, Ugahary LC, van Dissel JT, van Meurs JC (2005) Effect of intravitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 243:1186–1189CrossRefPubMed
Metadata
Title
Pharmacokinetics and efficacy of intraocular flurbiprofen
Authors
S. Blazaki
C. Tsika
M. Tzatzarakis
E. Naoumidi
A. Tsatsakis
C. Tsatsanis
Miltiadis K. Tsilimbaris
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 12/2017
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-017-3812-9

Other articles of this Issue 12/2017

Graefe's Archive for Clinical and Experimental Ophthalmology 12/2017 Go to the issue