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Jessica Prince-Wolfish, Jeremy Cotliar, Arash Mozayan, Wen-Jeng (Melissa) Yao, Jeffrey S. Schultz; Safety of Difluprednate 0.05% after Cataract Surgery in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6695. doi: https://doi.org/.
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Post-operative inflammation associated with cataract surgery can lead to serious complications. The use of corticosteroid drops is paramount in the post-operative period to reduce inflammation. Studies have shown that corticosteroids can increase intraocular pressure (IOP), which can be particularly harmful to the glaucoma patient population. Recently, difluprednate 0.05% has emerged as an effective corticosteroid to control post-operative inflammation. The purpose of this study is to examine the effect of difluprednate on IOP in glaucoma patients who underwent cataract surgery.
A retrospective chart review was performed on glaucoma patients who underwent cataract surgery by one surgeon from June 2010 to June 2011 at one institution in Bronx, NY. Only those patients who were treated with difluprednate 0.05% immediately post-operatively at four times daily and then tapered according to level of inflammation were included in the study. Exclusion criteria included patients who underwent previous glaucoma incisional surgery, needed higher dosing of difluprednate than four times daily, had pre-operative IOP greater than or equal to 21 mmHg, or were not taking IOP lowering medication. Pre-operative, post-operative week 2 (POW2), and post-operative week 6 (POW6) IOPs were analyzed. The criteria for a positive steroid response in this study was defined as an IOP increase greater than or equal to 10 mmHg than pre-operatively or an IOP greater than or equal to 21 mmHg at any point post-operatively.
Based on the above criteria, sixty-five patients were included in the analysis. Twenty-seven patients were on one IOP lowering drop, twenty-three patients on two drops, eleven patients on three drops, and four patients were on four drops. The average IOP pre-operatively, on POW2, and on POW6 were 15.09 mmHg, 14.80 mmHg, and 14.30 mmHg, respectively. Five patients (7.7%) had an IOP measurement greater than or equal to 21 mmHg. One of these patients also fit the criteria of an IOP increase greater than or equal to 10 mmHg (from 13 to 25 mmHg). All of these elevated IOPs were recorded at POW2 and subsequently resolved by POW6.
Difluprednate 0.05% has recently emerged as a new alternative to generic prednisolone acetate 1%, as it may offer more drop uniformity and require less frequent dosing for anterior uveitis. No previous study has looked at the effect of difluprednate on the glaucoma patient population. In this retrospective study, difluprednate appears to be safe in treating post-cataract extraction inflammation in glaucoma patients.
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