Inflammatory response after phacoemulsification treated with 0.5% prednisolone acetate or vehicle

Lorenz, Katrin; Dick, Burkhard; Jehkul, Andreas; Auffarth, Gerd U.

doi:10.1007/s00417-008-0908-2

Cited by 20 publications

(22 citation statements)

References 21 publications

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“…Contrary to studies reporting 2 [4] or 3 weeks [1,3], such a duration seems inadequate as the incidence of any E/T/H was approximately equal to 10% on day 21. In any case, given that the degree of inflammation is a function of time, it seems that future trials on topical agents after phacoemulsification should examine the heterogeneity in treatment duration, if any, and provide analyses of the effect of treatment duration on their examined outcomes.…”

Section: Discussionmentioning

confidence: 78%

“…Interestingly, the duration of postoperative treatment remains an open field, as studies report various treatment intervals such as 2 weeks [4], 3 weeks [1,3], 4 weeks [2,8] or an unspecified range between 4 and 6 weeks [5,6]. To our knowledge, no study has focused on the ‘optimal’ duration of postoperative treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Several combinations of postoperative treatment regimens/arms have been assessed after cataract surgery, such as a topical steroid plus antibiotic [1,2,3], a nonsteroid plus antibiotic [2], a steroid agent alone [4,5], a nonsteroid agent alone [6,7] or a combination of a nonsteroid with a steroid agent [5]. The different treatment regimens have aimed at reducing postoperative inflammatory response and infection rates after cataract surgery.…”

Section: Introductionmentioning

confidence: 99%

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Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

2010

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Background/Aims: To evaluate the benefit of adding a nonsteroid agent to an antibiotic/steroid combination after uneventful phacoemulsification, adopting a weekly follow-up, to gain insight into the optimal duration of postoperative treatment and to examine whether risk factors for inflammation exist. Methods: Patients were randomized to (i) tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d. (n = 72), and (ii) a combination of tobramycin 0.3%-dexamethasone 0.1%, 1 drop q.i.d., plus ketorolac tromethamine 0.5%, 1 drop t.i.d. (n = 73). On days 7, 14, 21 and 28, the frequency of inflammation-related signs (corneal edema, conjunctival hyperemia, anterior chamber or Tyndall reaction) as well as best-corrected visual acuity (BCVA) were measured. On day 21, logistic regression was performed to evaluate risk factors for inflammation. Results: The frequency of inflammation-related signs did not differ between the 2 groups at any time point, neither did BCVA. On day 21, pseudoexfoliation was associated with the presence of any inflammation-related sign (OR = 4.5; 95% CI: 1.2–16.0; p = 0.022). No evidence of clinically significant cystoid macular edema became evident in either group. Conclusion: The addition of ketorolac did not seem to offer any additional benefit in terms of inflammation-related signs. Four weeks appeared as an adequate treatment interval. Special attention should be paid to patients with pseudoexfoliation.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

2010

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“…Lorenz et al [42] studied the effects of prednisolone acetate 0.5% on intraocular inflammation after phacoemulsification. Prednisolone acetate 0.5% or placebo was instilled in 62 patients four-times daily until day 2 post-operatively.…”

Section: Topical Ocular Corticosteroids: Differences In Reporting Intmentioning

confidence: 99%

Intraocular Pressure Effects of Common Topical Steroids for Post-Cataract Inflammation: Are They All the Same?

Pleyer

Ursell

Rama³

2013

Ophthalmol Ther

102

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The efficacy of topical corticosteroids as ocular anti-inflammatory agents following cataract surgery is well-documented. They also help to prevent a number of complications associated with post-operative ocular inflammation, including corneal edema and cystoid macular edema. However, topical corticosteroids are associated with side effects, such as increased intraocular pressure (IOP). Indeed, corticosteroid-induced ocular hypertension and the potential for steroid-induced glaucoma remain the leading drawbacks of topical corticosteroid therapy. Some individuals are known to experience a high degree of IOP elevation with low doses or short durations of treatment with topical corticosteroids. Careful monitoring of IOP in such individuals is essential. Few randomized, controlled studies are available on the comparative safety and efficacy of common topical corticosteroids in the treatment of post-operative ocular inflammation. Furthermore, the lack of consistent reporting criteria for clinically significant IOP increases across clinical studies makes meaningful comparisons among corticosteroids difficult. This review aims to examine data from available published studies, including studies in steroid responders, to determine whether topical corticosteroids are the same in terms of their effect on IOP. Early generation corticosteroids, such as dexamethasone and prednisolone, are more likely to result in clinically significant increases in IOP. Newer corticosteroids, such as rimexolone and the retro-metabolically designed corticosteroid, loteprednol etabonate, offer similar anti-inflammatory efficacy to older corticosteroids with less effect on IOP. However, randomized controlled trials of newer corticosteroids are needed. The proportion of patients exhibiting an increase of ≥10 mmHg IOP in clinical studies has emerged as the most clinically relevant parameter for ophthalmologists to consider when deciding on which topical corticosteroid to use.

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“…9,10 Controlled studies have demonstrated that topical steroids are effective and have a favourable safety profile in suppressing ocular inflammation and reducing the long-term likelihood of vision impairment when administered at the time of surgery and during the weeks afterwards. 10,11 Difluprednate ophthalmic emulsion 0.05% is a topical ocular corticosteroid that has been approved since 2008 for use in adults, initially for treatment of inflammation and pain associated with ocular surgery, and subsequently for treatment of endogenous anterior uveitis. 12,13 Recent studies in adults have shown that difluprednate treatment is associated with rapid resolution of both inflammation and pain associated with ocular surgery.…”

Section: Introductionmentioning

confidence: 99%

Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study

Wilson

Lambert

Plager

et al. 2016

Eye

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Purpose To evaluate safety and efficacy of difluprednate 0.05% ophthalmic emulsion for treatment of postoperative inflammation after cataract surgery in pediatric patients. Methods This was a phase 3B, multicentre, randomized, double-masked, active-controlled study of patients aged 0-3 years who underwent uncomplicated cataract surgery in one eye, with/without intraocular lens implantation. Patients were randomized to receive difluprednate 0.05% four times daily or prednisolone acetate 1% for 14 days post surgery, followed by tapering for 14 days. Safety included evaluation of adverse events. Primary efficacy was the proportion of patients with an anterior cell grade of 0 (no cells) at day 14; secondary efficacy was a global inflammation score. Results Forty patients were randomized to each treatment group. Adverse drug reactions included corneal oedema (difluprednate 0.5%, n = 1; prednisolone acetate 1%, n = 0) and increased intraocular pressure or ocular hypertension (n = 2/group). Mean intraocular pressure values during treatment were 2-3 mm Hg higher with difluprednate 0.05% compared with prednisolone acetate 1%; mean values were similar between groups by the first week after treatment cessation. At 2 weeks post surgery, the incidence of complete clearing of anterior chamber cells was similar between groups (difluprednate 0.05%, n = 30 (78.9%); prednisolone acetate 1%, n = 31 (77.5%)). Compared with prednisolone acetate 1%, approximately twice as many difluprednate 0.05%-treated patients had a global inflammation assessment score indicating no inflammation on day 1 (n = 12 (30.8%) vs n = 7 (17.5%)) and day 8 (n = 18 (48.7%) vs n = 10 (25.0%)). Conclusions Difluprednate 0.05% four times daily showed safety and efficacy profiles similar to prednisolone acetate 1% four times daily in children 0-3 years undergoing cataract surgery.

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Inflammatory response after phacoemulsification treated with 0.5% prednisolone acetate or vehicle

Abstract: 0.5% prednisolone acetate appeared to be significantly more effective as vehicle in controlling intraocular inflammation after phacoemulsification; both groups had a similar safety profile.

Cited by 20 publications

References 21 publications

Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

Ketorolac plus Tobramycin/Dexamethasone versus Tobramycin/Dexamethasone after Uneventful Phacoemulsification Surgery: A Randomized Controlled Trial

Intraocular Pressure Effects of Common Topical Steroids for Post-Cataract Inflammation: Are They All the Same?

Difluprednate versus prednisolone acetate for inflammation following cataract surgery in pediatric patients: a randomized safety and efficacy study

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