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Qianqian Wang, Paul Harasymowycz; Short-term Intraocular Pressure Spike after Combined Phacoemulsification and iStent Implantation: Prednisolone versus Loteprednol. Invest. Ophthalmol. Vis. Sci. 2013;54(15):761. doi: https://doi.org/.
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Intraocular pressure (IOP) spike may be a short-term complication after combined phacoemulsification and iStent implantation (phaco-iStent). This study aims to compare the impacts of topical prednisolone (P) and of loteprednol (L) on post-operative IOP evolution and to assess their glaucoma medication sparing effects.
A retrospective chart review was done for patients who underwent phaco-iStent between April 2011 and October 2012. Post-operatively, every patient received a 4-week tapering regimen of either prednisolone or loteprednol. Baseline demographic and clinical data was compared by Student t and chi-square tests. Evolution of IOP and of number of glaucoma medications (NGM) at pre-operative visit, post-operative day 1 (POD 1), 1-2 weeks, 3-4 weeks and 2-3 months was assessed by mixed model for repeated measures.
We identified 124 eyes (L: 79, P: 45) from 96 patients. Pre-operative demographic and clinical parameters are similar (p>0.05) across both groups. The IOP increased from 17.6 [(range) 9-33] mmHg pre-operatively to 21.4 [9 - 41] mmHg at 1-2 weeks in loteprednol group, and from 15.6 [8 - 30] to 19.1 [5 - 50] mmHg in prednisolone group. It then decreased (p<0.0001) by 3-4 weeks in both groups (L: 15.9 [7 - 30] mmHg; P: 14.7 [4 - 28] mmHg) and continued to improve at 2-3 months. NGM showed significant decrease (p<0.0001) from pre-operative visit (L: 2.2 [0-5]; P: 1.8 [0-4]) to POD 1 (L:0.4 [0-4]; P: 0.6 [0-4]), then remained stable in both groups. No significant difference in IOP or NGM evolution between the 2 groups was detected (p>0.05). The proportion of patients with an IOP spike of 5 mmHg or more (p=0.57) and that of patients needing wound burp (p=0.37) are also similar in both groups.
In our phaco-iStent patients, loteprednol had similar effects to prednisolone in post-operative IOP evolution and glaucoma medication sparing.
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