Reply

We appreciate the interest that our work has generated, and we take this opportunity to address Dr. Levitz’s concerns. In our paper, we wanted to evaluate whether the addition of NSAID eyedrops to topical steroids could benefit patients with PXF after cataract surgery. The primary efficacy endpoint of the study was a 30% postoperative reduction in anterior chamber flare in Group 1 when compared with Group 2 at 3 days. Eyes in Group 1 received dexamethasone 0.1% and tobramycin 0.3%. Eyes in Group 2 received bromfenac drops in addition. Anterior chamber inflammation was measured with a FM-700 laser flare meter (Kowa Co. Ltd.). We showed that the addition of bromfenac to dexamethasone drops significantly reduced the postoperative flare in PXF patients. Macular edema was clearly proposed as 1 of the secondary endpoints of our study. The clinical trial was designed and the sample size calculated to address the primary endpoint. We agree that a study of the effect of NSAIDs on postoperative macular edema would have required a larger number of participants. The relative value of our findings on CME and the relevance of this secondary endpoint were discussed in detail in the Discussion section of our paper. Dexamethasone drops were prescribed 4 times a day and then tapered, as is often done after cataract surgery. Both groups received therapy for 2 weeks because bromfenac is not approved for longer treatment in the European Union. We agree that data on longer or stronger treatment regimens would have been of interest. We see that patients in the experimental group received more drops than the ones in the standard group. This is in line with our purpose, which was to study the effect of adding topical NSAIDs to steroids.