Critical appraisal of loteprednol ointment, gel, and suspension in the treatment of postoperative inflammation and pain following ocular and corneal transplant surgery

Pirouzian, Amir; Craven, E. Randy

doi:10.2147/opth.s30278

Cited by 9 publications

(4 citation statements)

References 43 publications

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“…Of 1863 systematic reviews on eyes and vision in our database as of March 2016, we identified 99 that evaluated management strategies for cataract in the adult eye and were eligible for this project (Figure 1). The earliest review was published in 1994, but more than half were published after 2012 (Table 2). Twenty of 99 reviews (20%) were published by CEV authors in The Cochrane Database of Systematic Reviews .…”

Section: Resultsmentioning

confidence: 99%

“…Twenty of 99 reviews (20%) were published by CEV authors in The Cochrane Database of Systematic Reviews . Of the 79 non-Cochrane reviews, 50 (63%) were published in specialty medical journals (eg, Ophthalmology ). Intraocular lenses (IOL) implantation was the most commonly examined intervention (25 of 99 [25%]), followed by phacoemulsification (20 of 99 [20%]).…”

Section: Resultsmentioning

confidence: 99%

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Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

et al. 2018

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IMPORTANCETrustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP).OBJECTIVE To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines.MAIN OUTCOMES AND MEASURES Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings. RESULTSFrom 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines. CONCLUSIONS AND RELEVANCEThe partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

et al. 2018

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“…A preservative-free LE ointment 0.5% formulation became available in 2011. Ointment formulations may be beneficial for patients with tremors or arthritis as well as others who may have trouble instilling drops into their eyes [53], and remain on the ocular surface significantly longer than ophthalmic solutions, making them particularly suitable for nighttime use [54].…”

Section: Le Ointmentmentioning

confidence: 99%

Loteprednol etabonate for inflammatory conditions of the anterior segment of the eye: twenty years of clinical experience with a retrometabolically designed corticosteroid

Comstock¹,

Sheppard

2018

Expert Opinion on Pharmacotherapy

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Topical corticosteroids are an important pharmacotherapy for the management of various inflammatory conditions affecting the anterior segment of the eye. However, medications in this class are associated with well-known risks including increased intraocular pressure (IOP) and development of cataracts. The topical corticosteroid loteprednol etabonate (LE) was developed with the specific intention of minimizing these side effects. Areas covered: The focus of this review is to examine published efficacy and safety data for LE, a drug engineered to undergo rapid metabolism to inactive metabolites with the goal of improved safety. Two decades of clinical research focused on LE formulations are reviewed, including the use of LE in combination with tobramycin. The cumulative body of experience affirms the concept that the molecular design of LE confers certain safety benefits without compromising the desired anti-inflammatory efficacy of a topical corticosteroid. Expert opinion: Loteprednol etabonate is a mainstay for topical therapy of a wide variety of commonplace and niche conditions of the ocular surface and the anterior segment, including in the healing post-operative patient. Its versatility and safety allow eye care providers to recommend both acute induction as well as chronic maintenance therapy with appropriate follow-up.

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“…The increased surface area of these junction areas leads to improved tensile strength of the wound, allowing for earlier sutures removal and potentially reducing graft rejection [12]. Then patients can also be safely switched to less potent topical steroid medications which are known to have fewer long-term side effects for chronic maintenance of immune-suppressive therapy [13].…”

Section: Discussionmentioning

confidence: 99%

Femtosecond Assisted Deep Lamellar Keratoplasty in a 4½ Year Old Child for Traumatic and Infectious Corneal scar- A Case Report

Pirouzian¹

2015

Open J Pediatr Child Health

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To report a case of central deep corneal scar secondary to trauma and subsequently resolved fungal infection in a 4½ year old and secondary amblyopia treated with femtosecond-assisted deep lamellar keratoplasty (FALK). Methods: A 4½ year old male patient with reduced vision and photophobia as a result of a centrally dense mid-stromal corneal scar in the right eye was referred to Gavin Herbert Eye Institute, University of California, Irvine, by an out of state ophthalmologist for consideration of femtosecondassisted laser lamellar keratoplasty. Following a complete ocular examination, FALK was performed under general anesthesia. Results: The original non-perforating cornea trauma had occurred 10-months previously while the child had accidentally run into a branch of a tree, penetrating the right central cornea and resulting in Aspergillus corneal infection. The penetrating cornea injury was repaired and the ensuing infection was treated with a course of topical antifungal medications. After resolution of the infection, a deep and dense mid-stromal scar, obstructing visual axis, had developed. Irregular astigmatism and secondary amblyopia were present. The zigzag pattern FALK using Intralase TM laser (AMO, Santa Ana, CA) for both donor and recipient cuts was performed. Conclusions: This is the first case report of traumatic central corneal scar from trauma and infection resulting in amblyopia, which was successfully treated with zigzag-shaped femtosecond assisted laser lamellar keratoplasty in a young child.

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Critical appraisal of loteprednol ointment, gel, and suspension in the treatment of postoperative inflammation and pain following ocular and corneal transplant surgery

Cited by 9 publications

References 43 publications

Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye

Loteprednol etabonate for inflammatory conditions of the anterior segment of the eye: twenty years of clinical experience with a retrometabolically designed corticosteroid

Femtosecond Assisted Deep Lamellar Keratoplasty in a 4½ Year Old Child for Traumatic and Infectious Corneal scar- A Case Report

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