An observational comparative study of intraocular pressure changes in post-operative cataract patients treated with dexamethasone, difluprednate and prednisolone in a tertiary care centre
Keywords:Difluprednate, Prednisolone, Intraocular pressure
Background: Cataract is opacity of lens which is treated surgically. Topical corticosteroids are routinely used in the treatment of post-operative inflammation following cataract surgery. This study aims to compare the intraocular pressure changes caused by various topical steroids (prednisolone, dexamethasone and difluprednate) in post cataract patients. To compare compliance and to detect any significant adverse effects.
Methods: Patients admitted in ophthalmology department for cataract surgery operated by phacoemulsification were taken as subjects. Total number of patients enrolled in the study were 354. Subjects were separated into 3 groups depending on topical steroids which were prescribed after surgery: group 1 - difluprednate, group 2 -dexamethasone and group 3 - prednisolone. Changes in intraocular pressure (IOP) of patients were measured by ophthalmology department preoperatively and postoperatively after 1st, 2nd, 3rd, 4th week of surgery. These data were collected and analysed. Adverse effects, Compliance of patients and number of bottles of drug used after surgery were also noted.
Results: On comparing IOP, there was significant variation (p<0.027) between 3 drugs after one week of drug administration. When group 1 was compared with group 2 or group 3 there was no significant difference Average cost of difluprednate is about 3 times higher than the cost of dexamethasone or prednisolone.
Conclusions: All the three topical steroids cause a rise in intraocular pressure in post cataract patients. But in group 1 (difluprednate) there was a rise in IOP up to three weeks after surgery but after 3rd week IOP remained stable. Adverse effects were seen more in group 2 and group 3.
El-Harazi SM, Feldman RM. Control of intra-ocular inflammation associated with cataract surgery. Curr Opin Ophthalmol. 2001;12:4-8.
The Loteprednol Etabonate Postoperative Inflammation Study Group 2. A double-masked, placebo-controlled evaluation of 0.5% loteprednoletabonate in the treatment of postoperative inflammation. The Loteprednol Etabonate Postoperative Inflammation Study Group 2. Ophthalmology. 1998;105:1780-6.
Bron A, Denis P, Hoang-Xuan TC, Boureau-Andrieux C, Crozafon P, Hachet E, Medhorn E, Akingbehin A. The effects of Rimexolone 1% in postoperative inflammation after cataract extraction. A double-masked placebo-controlled study. Eur J Ophthalmol. 1998;8(1):16-21.
Korenfeld MS, Silverstein SM, Cooke DL, Vogel R, Crockett RS. Difluprednate ophthalmic emulsion 0.05% for postoperative inflammation and pain. J Cataract Refract Surg. 2009;35:26-34.
Stewart R, Horwitz B, Howes J, Novack GD, Hart K. Double-masked, placebo-controlled evaluation of loteprednoletabonate 0.5% for postoperative inflammation. Loteprednol Etabonate Post-operative Inflammation Study Group 1. J Cataract Refract Surg. 1998;24:1480-9.
Campos M, Avila M, Wallau A, Muccioli C, Höfling-Lima AL, Belfort R. Efficacy and tolerability of a fixed-dose moxifloxacin—dexamethasone formulation for topical prophylaxis in LASIK: a comparative, double-masked clinical trial. Clin Ophthalmol. 2008;2:331-8.
Holland EJ, Djalilian AR, Sanderson JP. Attenuation of ocular hypertension with the use of topical loteprednoletabonate 0.5% in steroid responders after corneal transplantation. Cornea. 2009;28:1139-43.
Seah SK, Husain R, Gazzard G, Lim MC, Hoh ST, Oen FT, Aung T. Use of surodex in phacotrabeculectomy surgery. Am J Ophthalmol. 2005;139(5):927-8.
Vetrugno M, Maino A, Quaranta GM, Cardia L. The effect of early steroid treatment after PRK on clinical and refractive outcomes. Acta Ophthalmol Scand. 2001;79:23-7.
Rugstad HE, Antiinflammatory and immunoregulatory effects of glucocorticoids: mode of action. Scand J Rheumatol Suppl. 1988;76:257-64.
Tranos P, Bhar G, Little B. Postoperative intraocular pressure spikes: the need to treat. Eye. 2004;18:673-9.
Kolker AE. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc. 1977;75:539-55.
Patil A, Gupta V, Sethi H, Nehate R. A comparative evaluation of anti-inflammatory efficacy of various ophthalmic steroids in post phacoemulsification patients. European Society of Cataract and Refractive Surgeons. 2013.
Roth SM, Spaeth GL, Starita RJ, Birbillis EM, Steinmann WC. The effects of postoperative corticosteroids on trabeculectomy and the clinical course of glaucoma: five-year follow-up study. Ophthalmic Surg. 1991;22(12):724-9.
Laurell CG, Zetterstrom C. Effects of dexamethasone, diclofenac, or placebo on the inﬂammatory response after cataract surgery, Br J Ophthalmol. 2002;86:1380-4.
Tripathi RC, Parapuram SK, Tripathi BJ, Zhong Y, Chalam KV. Corticosteroids and glaucoma risk. Drugs Aging. 1999;15:439-50.
Bartlett JD, Woolley TW, Adams CM. Identiﬁcation of high intraocular pressure responders to topical ophthalmic corticosteroids. J Ocul Pharmacol. 1993;9:35-45.
Bartlett JD, Horwitz B, Laibovitz R, Howes JF. Intraocular pressure response to loteprednoletabonate in known steroid responders. J Ocul Pharmacol. 1993;9:157-65.
Korenfeld MS, Silverstein SM, Cooke DL, Vogel R, Crockett RS, et al, Difluprednate ophthalmic emulsion 0.05% for postoperative inflammation and pain. J Cataract Refract Surg. 2009;35(1):26-34.
Sheppard JD, Toyos MM, Kempen JH, Kaur P, Foster CS. Difluprednate 0.05% versus prednisolone acetate 1% for endogenous anterior uveitis: a phase III, multicenter, randomized study. Invest Opthalmol Vis Sci. 2014;55(5):2993-3002.
Sood P, Bhanot M, Singh N. Comparison of safety of loteprednol 0.5%/difluprednate 0.05%/prednisolone 1% eye drops in the post cataract surgery patients. Int J Basic Clin Pharmacol. 2016;5(6):2368.