A Retrospective Review of IOP Elevations With Use of Loteprednol Etabonate

Abstract

Purpose: : To characterize the timing and severity of intraocular pressure elevations with loteprednol etabonate 0.5%.

Methods: : Retrospective chart review at four private practice sites of patients who developed elevations in IOP (>5 mm Hg) while using loteprednol etabonate 0.5% (Lotemax) or loteprednol etabonate 0.5%/tobramycin 0.3% (Zylet). Data collected included patient demographics, medical and ophthalmic history, ophthalmic and systemic diseases, concomitant medications, condition for which Lotemax/Zylet were prescribed, IOP, as well as medical and surgical interventions.

Results: : A total of 40 patients experienced IOP elevations after use of topical loteprednol. The mean patient age was 57.3 (± 19.5) years and 75% were female. The most common reasons for prescribing loteprednol was dry eye (37.5%), postoperative therapy (14.5%), and allergic conjunctivitis (14.5%). Prior to treatment, 12.5% of patients (n=5) had a history of open-angle glaucoma (OAG) and 5% (n=2) had ocular hypertension (OHT). Mean IOP before treatment was 15.2 (± 2.6) mm Hg and increased to a mean of 22.4 (± 3.1), a statistically significant increase of 7.2 (± 2.8, range: 5-18) mm Hg (P<.001). The median duration of treatment with loteprednol at the time of observed IOP elevation was 5 weeks (range: 3 days - 3 years). Elevated IOP was observed within eight weeks in 62.5% of patients and between 8 and 12 weeks in an additional 17.5% of patients. Only one patient required a surgical intervention (SLT) for elevated IOP post discontinuation of treatment.

Conclusions: : Use of loteprednol may be associated with elevations in IOP even in patients without a prior history of glaucoma or ocular hypertension. Sustained use beyond acute treatment is more likely to result in IOP elevations. If chronic treatment is required for an ocular surface condition, alternatives to corticosteroids should be considered.

Keywords: intraocular pressure • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials