How is Prolensa (bromfenac) used?

Prolensa (Bromfenac) Usage Guidelines

Prolensa (bromfenac ophthalmic solution 0.07%) is indicated for the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract surgery, administered as one drop once daily beginning 1 day before surgery, on the day of surgery, and for 14 days after surgery. 1

Administration Protocol

• Dosing Schedule:

  • Begin treatment 1 day before cataract surgery
  • Continue on the day of surgery
  • Continue for 14 days after surgery (total treatment duration: 16 days) 2, 3
  • Apply one drop to the affected eye once daily

• Administration Technique:

  • Wash hands thoroughly before application
  • Tilt head back slightly and pull down the lower eyelid to create a pocket
  • Place one drop in the affected eye
  • Close eyes gently for 1-2 minutes to allow absorption
  • Avoid touching the dropper tip to any surface to prevent contamination

Efficacy

Bromfenac 0.07% has demonstrated superior efficacy compared to placebo in:

• Reducing ocular inflammation:

  • Significantly higher proportion of patients achieve complete clearance of ocular inflammation by day 15 post-surgery (p<0.0001) 2
  • Lower mean summed ocular inflammation scores at days 3,8,15, and 22 post-surgery 3

• Reducing ocular pain:

  • Significantly higher proportion of patients are pain-free at all study visits compared to placebo (p<0.0001) 2
  • Pain relief begins as early as day 1 post-surgery 3

Clinical Advantages

• Once-daily dosing:

  • Improved patient compliance due to less frequent administration 4
  • Sufficient ocular penetration and duration of action to permit once-daily dosing 5

• Formulation benefits:

  • Lower pH formulation allows for reduced concentration (0.07%) while maintaining similar bioavailability to previous 0.09% formulation 5
  • May result in fewer ocular adverse events compared to higher concentration formulations

Safety Profile

• Common adverse events affecting the eye:

  • Eye pain
  • Anterior chamber inflammation
  • Foreign body sensation
  • Photophobia
  • Conjunctival hyperemia
  • Corneal edema 5

• Safety considerations:

  • Lower incidence of adverse events compared to placebo in clinical trials (p=0.0041) 2
  • Caution in patients with pre-existing corneal disease due to reports of corneal compromise 4
  • Avoid use in patients wearing contact lenses

Monitoring

• Evaluate patients on days 1,3,8,15, and 22 after surgery to assess:
  • Resolution of inflammation (anterior chamber cell count and flare)
  • Pain relief
  • Visual acuity improvement
  • Potential adverse events 2, 3

Expanded Uses

While Prolensa is FDA-approved specifically for postoperative inflammation and pain after cataract surgery, NSAIDs like bromfenac are seeing expanded use for:

• Treatment and prevention of cystoid macular edema
• Potential utility in other diseases of vascular permeability 4

Important Considerations

• Discontinuation rates due to lack of efficacy are significantly lower with bromfenac (3.2%) compared to placebo (23.9%) 2
• By day 15,84% of bromfenac patients show ≥1-line improvement in visual acuity compared to 66.1% of placebo patients 3
• Avoid using in combination with topical anesthetics for outpatient use as they can delay healing 6

Bromfenac ophthalmic solution 0.07% (Prolensa) represents an effective option for managing postoperative inflammation and pain following cataract surgery, with the convenience of once-daily dosing and a favorable safety profile.