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Daniel Feiler, Careen Y Lowder, Kimberly Baynes, Sunil K Srivastava; The effect of topical difluprednate on vascular leakage in non-infectious uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3309.
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© ARVO (1962-2015); The Authors (2016-present)
Although uveitis activity and response to treatment are typically defined clinically, fluorescein angiography (FA) and optical coherence tomography (OCT) are widely used to monitor disease activity. Evidence for optimal treatment strategies for uveitic vascular leakage is lacking. We evaluate the effect of topical difluprednate on vascular leakage in patients with uveitis.
Nine eyes of six patients (2 sarcoidosis, 4 idiopathic) with uveitic vascular leakage documented via FA were treated with one drop of topical difluprednate (0.05%) four times daily for 3 weeks and tapered over 1 month. Charts were reviewed for best-corrected Snellen visual acuity (VA), intraocular pressure (IOP), exam findings, and fluorescein angiography results. FA was compared across visits for change in posterior as well as peripheral vascular leakage. Change in minimum angle of resolution VA and IOP were assessed using paired two-tailed T tests to assess statistical significance.
Eight (89%) of eyes had a decrease in vascular leakage on FA at follow-up (mean 59±18 days). Six (85%) of the seven eyes with identifiable peripheral vascular leakage had a decrease in PVL. One patient, two eyes, had significant peripheral pigmentary changes making assessment of PVL impossible. Mean logarithm of the minimum angle of resolution VA improved by 0.055±0.203 (p=0.794) at 60 days. Mean change in IOP was +1.55±0.6mmhg (p=0.043) at 30 days, and -0.57±1.0mmhg (p=0.578) at 60 days. No significant ocular or systemic adverse effects were observed.
These results suggest that topical difluprednate is a well-tolerated and effective treatment for uveitic vascular leakage with FA documented decrease in vascular leakage and PVL in nearly all of the treated patients. There was no significant change in VA and there was a mild, yet statistically significant increase in intraocular pressure which resolved in all cases with difluprednate taper. Further evaluation of topical difluprednate for uveitis in controlled randomized studies is warranted.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1. Montage of representative fluorescein angiograms.
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