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Anna Djougarian, Gerald W. Zaidman; Difluprednate 0.05% following Corneal Transplant Surgery (CTS) in Infants and Children. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1978. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the efficacy and complications of difluprednate in pediatric patients following CTS compared to other topical corticosteroids.
A chart review was conducted of pediatric patients 16 years or younger operated on from 2000-2010. Eyes were separated into 2 groups: Group A was treated with difluprednate 0.05% and Group B was treated with other topical corticosteroids - prednisolone acetate 1%, fluorometholone 0.25%, sulfacetamide sodium 10%/prednisolone acetate 0.2%, tobramycin 0.3%/dexamethasone 0.1%, rimexolone 1%, neomycin sulfate equivalent to neomycin 3.5 mg/polymyxin B sulfates 10,000 units/dexamethasone 0.1% and loteprednol etabonate 0.5%. Complications were determined by the occurrence of glaucoma and cataracts. Efficacy was measured by the prevention of transplant rejection.
Group A had 15 eyes of 13 children, between 3 months and 11 years old. Children were followed for 1 to 15 months. 9 eyes had controlled glaucoma from treatment with topical corticosteroids prior to difluprednate; the remaining 6 were treated only with difluprednate and of these, 3 eyes had glaucoma prior to difluprednate while 3 did not. In the 9 eyes with glaucoma, switching to difluprednate led to normal pressures in 6 eyes, with persistently elevated pressures in 3 eyes. In the other 6 eyes treated with difluprednate, use of difluprednate led to medically controlled glaucoma in 3 eyes, all of which already had elevated intraocular pressure (IOP) before treatment. The other 3 eyes remained normal. None needed glaucoma surgery. 1 eye required cataract surgery. 2 grafts failed. Group B had 35 eyes of 28 children, between 3 months to 18 years old. Follow-up ranged from 1 month to 10 years. 32 (91.4%) of the 35 eyes had glaucoma following treatment with topical corticosteroids, 3 (8.6%) did not. Of the 32 eyes with glaucoma, 16 (50%) had elevated IOP prior to surgery while 16 (50%) did not. The 3 eyes that did not have glaucoma following surgery had normal IOP prior to treatment with topical corticosteroids. 1 (2.9%) of the 35 eyes needed a glaucoma drainage implant. 12 (34.3%) required cataract surgery. 10 (28.6%) grafts failed.
Patients treated with difluprednate (Group A) had less problems with IOP, fewer cataract surgeries and less graft failures than Group B. This suggests that difluprednate may have less complications and may be more effective than other topical corticosteroids. However, the follow-up time in Group A was significantly shorter than Group B and some of these complications take time to occur.
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