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Daniel Feiler, Careen Y Lowder; Resolution of uveitic cystoid macular edema with topical difluprednate. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6175.
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© ARVO (1962-2015); The Authors (2016-present)
Cystoid macular edema (CME) represents a common cause of visual loss in patients with uveitis. Evidence for optimal treatment strategies is lacking. We evaluate the efficacy of topical difluprednate for the treatment of cystoid macular edema in patients with uveitis.
Seven eyes of six patients (4 sarcoidosis, 2 idiopathic) with uveitic cystoid macular edema treated with one drop of topical difluprednate (0.05%) four times daily for 3 weeks (5 eyes), 5 weeks (1 eye), or 9 weeks (1 eye) and tapered over 1 month were reviewed for best-corrected Snellen visual acuity (VA), optical coherence tomography (OCT), intraocular pressure (IOP), exam findings, and fluorescein angiography results. OCTs were compared across visits for change in central foveal thickness and intraretinal fluid (IRF). Change in central foveal thickness, minimum angle of resolution VA, and IOP were assessed using paired two-tailed T tests to assess statistical significance.
Seven (100%) eyes had a decrease in central foveal thickness at follow-up (mean 45±6days). Six (86%) eyes had an improvement of VA by at least 1 line. Mean logarithm of the minimum angle of resolution VA improved by 0.147±0.070 (p=0.079). Mean central foveal thickness decreased by 171.4μm±46.1 (p = 0.01). Seven (100%) eyes had complete resolution of IRF on OCT. Mean increase in IOP was 4.57mmhg±1.7 (p=0.034) after an average of 28 days, and 1.8mmhg±1.5 (p=0.272) after an average of 45 days. No significant ocular or systemic adverse effects were observed.
These results suggest that topical difluprednate is a well-tolerated and effective treatment for uveitic CME with resolution of IRF, decreased OCT central foveal thickness and a trend towards improvement in VA in all consecutively treated patients. There was a mild, yet statistically significant increase in intraocular pressure, however, this resolved in all cases with difluprednate taper. Further evaluation of topical difluprednate for uveitic CME in controlled randomized studies is warranted.
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