Preliminary evidence of neuropeptides involvement in keratoconus

toid macular oedema. This clinical study was conducted as a comparative, prospective, single-masked study, and administered at a single centre, private, teaching, multi-specialty practice in Las Vegas, Nevada. The study began on 4 April 2011 and ended on 31 August 2011. There were a total of 269 eyes (patients) enroled with 222 completing the study. Patients were randomized into two groups: Group I (nonsteroidal group – [besifloxacin ophthalmic suspension, 0.6% {Bausch & Lomb, Rochester, NY} and bromfenac 0.09% {ISTA Pharmaceuticals, Irvine, CA, USA}]) and Group II (steroid group – [besifloxacin and prednisolone acetate 1% {Allergan, Inc., Irvine, CA, USA}]). The dispensing protocol used is as follows: besifloxacin 0.6%, 1 drop in the operated eye, BID, for 3 days prior to surgery and to continue for 7 days postsurgery; prednisolone acetate 1%, 1 drop in the operated eye, QID for 7 days followed by a tapering dose totalling 14 days of treatment; and bromfenac 0.09%, 1 drop in the operated eye, QD, starting 3 days prior to surgery and continuing for a total of 14 days. This protocol was implemented in accordance with the AAO guideline and the standard of care set forth by the practice. Visual recovery and anterior segment inflammation were statistically insignificant with the p-value > 0.05 for all evaluation periods between the two groups. The foveal thickness (FT; p = 0.8 [1-week], p = 0.2 [1-month], p = 0.2 [2-months]) and total macular volume (TMV; p = 0.7 [1-week]; p = 0.1 [1-month]; p = 0.2 [2-months]) were not statistically significant between groups and the observed power was 0.902 and 0.666, respectively. The paradigm in pharmacotherapy postuncomplicated cataract surgery has deviated little from the ‘norm’ as indicated by the AAO Preferred Practice Pattern (American Academy of Ophthalmology 2006). Based on this current study and others, the authors believe that the pharmacological approach should be tailored to each patient, based on the patient’s ocular and medical history, undergoing cataract surgery as opposed to mass ‘standardized’ treatment for all patients. Tailoring the treatment will increase compliance, that is, fewer drugs and less complex or confusing dosing frequencies, enhance efficacy and decrease the cost to the patients. This study also demonstrated that topical NSAIDs are equally efficacious when compared to topical steroids and ophthalmologists should consider using a two-drug regimen in managing postoperative cataract extraction. However, we suggest that a larger prospective study comparing the two agents is warranted. Finally, the authors would like to incite a healthy dialogue as to what is best for our patients: the standard 3drug regimen or a tailored regimen.