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Edoardo Villani, Cesare Pirondini, Francesco Viola, Roberto Ratiglia; Soft steroid topical treatment for moderate to severe dry eye: pulse vs tapered therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4321.
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To review the efficacy and side effects of 2 different topical corticosteroid schemes (pulse vs tapered) for treatment of moderate to severe dry eye over a period of 12 months.
The medical records of all patients treated with loteprednol etabonate 0.5% for moderate to severe dry eye from 2007 to 2012 at the Ocular Surface Research Center of Fondazione IRCCS Policlinico of Milan were reviewed. Patients were treated with pulse (q.i.d. for 2 weeks) or tapered (t.i.d. for 1 week, b.i.d. for 2 weeks, q.d. for 4 weeks, every other day for 8 weeks) therapy. Topical corticosteroid treatment was repeated when needed. We included patients with at least 12 months of follow-up. Exclusion criteria were lymphoma, AIDS, sarcoidosis, diabetes mellitus, dystrophies or infections of the ocular surface, systemic drugs with known ocular surface toxicity, contact lens wear, previous ophthalmic surgery, and topical treatments other than loteprednol and artificial tears. Main outcome measures, evaluated over the 12 months period, included: the mean difference compared to baseline of OSDI score, BUT, corneal fluorescein and conjunctival lissamine green staining scores (CLEK scheme), the frequency of instillation of artificial tears, the total number of steroidal drops instilled, and the steroid-related side effects.
We included 90 patients, 28 treated with pulse scheme and 62 treated with tapered scheme. Baseline data showed no significant differences between the 2 groups. OSDI score showed a significant higher decrement in the tapered group compared to the pulse one (mean annual decrement compared to baseline: 27±8 vs 20±6; P<0.01, t-test). The mean frequency of artificial tears instillation was significantly lower in the tapered group (4.14±0.72 vs 5.10±0.77; P<0.01). The number of steroidal drops instilled showed no differences between the 2 groups (114±27 vs 118±39). The only steroid-related side effect recorded was 1 case of temporary ocular hypertension (IOP increase > 10mmHg) in the pulse group.
Our results indicate that topical loteprednol etabonate 0.5% is a safe and effective treatment for patients with moderate to severe dry eye. The tapered small dose approach seems to provide a better control of symptoms, requiring a lower rate of retreatments and heading to no difference in the total number of steroid drops annually instilled in the 2 groups.
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