Abstract
Purpose :
To present a series of patients where difluprednate was used as a sole topical agent for scleritis treatment. Discuss its effectiveness and side effect profile.
Methods :
An observational retrospective study of all patients with scleritis who used difluprednate as a single treatment agent from 1/1/2018 to 1/1/2020. Data collected at each visit was: age, race, sex, anatomic location of scleritis, presence of nodules or necrotizing sclera, changes in scleritis activity, IOP, number of difluprednate drops used, BCVA, and lens status. Exclusion criteria: use of NSAIDs, corticosteroids, and immunosuppressive drugs. Primary outcome was clinical resolution of scleritis. Resolution was defined as no anterior chamber cell, complete blanching of the ocular surface with 10% phenylephrine: no nodules or necrosis. Secondary outcome measures: change in lens status or cataract surgery; IOP elevation defined as IOP ≥24 mm Hg.
Results :
Twenty-five patients (35 eyes) were analyzed. Median age was 60 years (range 13-78) and 60% were female. Caucasians were the largest group (16; 64%). Forty percent had bilateral disease; 44% of patients had an underlying systemic disease. The majority (86%) had diffuse anterior disease. Eighty percent (28 eyes) achieved quiescence. Nine eyes had IOP elevation; 4 eyes had a decrease in 2 or more lines of vision, of which one required cataract surgery. Overall, 5 eyes underwent cataract surgery. Causes of decreased vision were, dry eye associated with difluprednate (2 eyes), cataract progression (1 eye), and compressive optic neuropathy unrelated with difluprednate use (1 eye).
Conclusions :
Difluprednate use alone achieved disease suppression in most eyes treated for anterior scleritis with few having progression of cataracts or IOP elevation. Further studies are needed to assess the efficacy of adjunct difluprednate use in patients refractory to NSAIDs and non-steroidal immunosuppressant treatment alone.
This is a 2021 ARVO Annual Meeting abstract.