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Fran Wu, Laura J Kopplin, George Mount, Sarah Read-Brown, James T Rosenbaum, Eric B Suhler, Phoebe Lin; Efficacy of topical difluprednate in the treatment of uveitic cystoid macular edema. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1871.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the efficacy of topical difluprednate in treating uveitic cystoid macular edema.
We conducted a retrospective chart review of patients who were prescribed difluprednate 0.05% by the uveitis division at our institution from January 1, 2009, through December 31, 2012. Time to resolution of CME, central macular thickness (CMT) as measured by OCT, best-corrected visual acuity, difluprednate dosing, and concurrent systemic immunosuppression were obtained from initial visit and follow-up visits through 6 months.
115 subjects were prescribed difluprednate over a 4-year period. 20 did not use it, the most common known reason being cost (9 subjects). 28 subjects were excluded for incomplete data or no follow-up. Of the remaining subjects, the primary listed indication for difluprednate treatment was anterior uveitis (n=62) and uveitic CME (n=9 patients or 12 eyes). The 9 subjects treated for CME had an average age of 43, and 7 (78%) were female. 2 eyes (17%) had concurrent anterior chamber inflammation. After initiating difluprednate, CME resolved in 10 eyes (83%) over an average of 1.15±0.75 months. For subjects with resolution of CME, mean CMT at initiation of treatment was 339±103 and at final follow-up was 285±49, with an average decrease of 53±58 microns (p=0.10). For all subjects treated for CME, the mean logMAR visual acuity at initiation of treatment was 0.58±0.52 and at final follow-up was 0.41±0.56, with an average gain of 0.18±0.14 (p=0.001). 7 subjects (78%) were on systemic immunosuppression prior to initiation of difluprednate treatment; of these, 6 (7 eyes) experienced resolution of CME, and 1 had systemic therapy increased prior to CME resolution. No subjects were started on systemic therapy or had systemic therapy decreased or stopped within the follow-up period. 2 (17%) eyes from 2 patients developed a change in IOP >10 mmHg (IOP max 30 and 53), both of which required topical therapy and eventually glaucoma surgery. 2 out of 10 phakic eyes underwent cataract surgery within 1 year of starting difluprednate treatment.
Difluprednate is an effective adjunctive or primary therapy in the treatment of uveitic CME, and is associated with a significant improvement in visual acuity. The corresponding decrease in CMT was not statistically significant.
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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