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

Abstract

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.

Comparison of the Safety and Efficacy of Loteprednol Etabonate 0.5%/Tobramycin 0.3% with Dexamethasone 0.1%/Tobramycin 0.3% Following Strabismus Surgery

“…Surgical trauma to the eye initiates the release of inflammatory mediators, resulting in hyperemia, pain, and scar formation (8,14). By inhibiting the activation of phospholipase A2, corticosteroids prevent arachidonic acid formation which is the first step in the inflammatory cascade.…”

“…By inhibiting the activation of phospholipase A2, corticosteroids prevent arachidonic acid formation which is the first step in the inflammatory cascade. In this way, they suppress cellular infiltration, capillary dilatation, fibroblast proliferation, collagen deposition, and scar formation (8,14). Earlygeneration topical corticosteroids, such as DM, have been used for a long time for relieving ocular inflammation after strabismus surgery [1][2][3]16].…”

“…Earlygeneration topical corticosteroids, such as DM, have been used for a long time for relieving ocular inflammation after strabismus surgery [1][2][3]16]. Although they are effective in suppressing postoperative inflammation, they also have the potential to induce adverse effects, such as an increase in IOP, delay in wound healing, and decrease in resistance to infections [3,14,17].…”

“…LE is indicated for the treatment of various ocular surface and anterior segment inflammatory conditions such as seasonal allergic conjunctivitis, blepharokeratoconjunctivitis, and uveitis [17,4]. It offers a safe and proven management of postoperative pain and inflammation after cataract surgery [6,14,17].…”

“…Recently, topical combination products of 0.5% LE/0.3% tobramycin (LE/T) or 0.1% DM/0.3% tobramycin (DM/T) are commonly used in the treatment of steroid-responsive ocular inflammation, and a risk of bacterial ocular infection exists [7][8][9][10][11][12][13]. LE/T has been found to be similar to DM/T in its antiinflammatory effects for cataract surgery [8,14]. However, there are no published reports on the use of an LE/T ophthalmic solution in the treatment of postoperative inflammation following strabismus surgery.…”