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Laura J Kopplin, George R Mount, Fran Wu, Sarah Read-Brown, James T Rosenbaum, Phoebe Lin, Eric B Suhler; Side effects of topical difluprednate in the treatment of non-infectious uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1868. doi: https://doi.org/.
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Difluprednate is a topical corticosteroid with increased ocular penetration utilized for the treatment of uveitis. We assessed the development of ocular complications following topical difluprednate therapy in the treatment of non-infectious uveitis.
We conducted a single center retrospective chart review of patients prescribed difluprednate from January 2009 to December 2012 by the Casey Eye Institute uveitis division. We examined the rates of intraocular pressure (IOP) elevation and of glaucoma or cataract surgery within one year of starting difluprednate treatment.
We identified 94 eyes of 70 patients treated with difluprednate for anterior segment inflammation (82 eyes) or uveitic macular edema (12 eyes). The majority of uveitis cases were idiopathic, with the most commonly identified etiologies being HLA-B27/spondyloarthropathy (13.8%), juvenile idiopathic arthritis (8.5%), tubulointerstitial nephritis and uveitis (7.4%) and Vogt-Koyanagi-Harada syndrome (6.4%). An increase over baseline of IOP ≥10 mmHg was observed in 25 eyes (26.6%) and 30 eyes (31.9%) developed an IOP ≥24 mmHg. The mean change in IOP was 8.9±15.9 mmHg. The maximal change in IOP occurred on average at 8.1±6.9 weeks (range 2-26 weeks). Elevated IOP typically responded to treatment with topical therapy; however, 9 eyes (9.6%) required glaucoma surgery within one year of starting difluprednate. Seven of 76 phakic eyes (9.2%) underwent cataract surgery within one year of initiating therapy.
IOP elevation is a common side effect of difluprednate treatment and requires careful monitoring. In our study, we observed a lower, although still significant, rate of IOP elevation compared with prior retrospective studies in other uveitic populations. Frequently, difluprednate associated IOP elevation can be managed with topical therapy, although a small subset of patients may require surgical intervention.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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