A retrospective analysis of the use of loteprednol etabonate ophthalmic suspension 0.5% following canaloplasty

Abstract

BackgroundWhile loteprednol etabonate (LE) suspension 0.5% is approved for the treatment of postoperative ocular inflammation, there have been no reported studies of its use in glaucoma patients undergoing canaloplasty.MethodsThis was a retrospective medical chart review conducted at a single US center. Data were collected on patients with glaucoma who underwent canaloplasty with or without cataract surgery, and were prescribed LE suspension 0.5% postoperatively. Outcomes evaluated included postsurgical inflammation (anterior chamber [AC] cells and flare), intraocular pressure (IOP), number of IOP-lowering medications, and postsurgical complications.ResultsData were collected on 204 patients (262 eyes) with a mean (SD) age of 71.6 (11.3) years. The most frequent LE dosing regimens at day 1, week 1, and month 1 postsurgery were QID (92.3%; 241/261), TID (52.6%; 133/253), and QD (65.5%; 78/119), respectively. Inflammation (AC flare and cells), mostly mild, was noted in 33.2% (86/259) of eyes on postoperative day 1 and 8.6% (21/244) of eyes at month 1. Mean IOP and mean number of IOP-lowering medications were significantly reduced from baseline (P<0.001) at all time points postoperatively. Complete (no IOP-lowering medication) or qualified (use of ≤2 IOP-lowering medications) surgical success was achieved in 78.8% and 90.6% of eyes, respectively, at month 6 and 63.4% and 92.7% of eyes at month 36. The most frequently observed postoperative complication was hyphema in 48.7% (126/259) eyes at day 1, which decreased to 0.4% (1/244) of eyes by month 1. IOP ≥30 mmHg was noted in 13 (5.3%) eyes at postoperative week 1 and rarely thereafter, and no patient discontinued therapy because of an IOP increase.ConclusionThese real-world data suggest that canaloplasty with or without cataract surgery managed postoperatively with LE suspension 0.5% is effective and safe in the glaucoma patient.

Incidence and Clinical Characteristics of Postoperative Endophthalmitis After Ab-Interno Canaloplasty

“…Additionally, ABiC does not require the implantation of devices or hardware but instead restores natural outflow channels with no significant amount of tissue damage. 1,[14][15][16][17][18][19] In our study, we noted a statistically non-inferior POE rate after ABiC, factoring in the lengthy time period and multiple surgeons of variable experience levels. The differences mentioned above of ABiC regarding anatomical approach and surgical technique may partially explain the lower rate of POE after ABiC seen at our institution compared to the higher rates of POE after MIGS procedures observed elsewhere.…”

“…13 For the bulk of the procedure, ABiC utilizes the initial incision created for phacoemulsification and does not require making any additional large-sized incisions that may further increase the risk for POE. [14][15][16][17][18][19] Notably, no cases of POE were observed after standalone ABiC (0/1332 cases, 0.00%; 95% CI: 0.00-0.28%). However, we emphasize that the purpose of this study was to characterize the rate and clinical features of POE cases after ABiC.…”

<p>Real world use of loteprednol etabonate ophthalmic gel 0.5% in cases representative of comorbid pathologies responding to minimally invasive glaucoma surgery</p>

“…There was also no difference in IOP in patients undergoing SLT who received LE suspension 0.5% at the time of surgery compared to those not receiving corticosteroid 37. In a retrospective evaluation of patients managed with LE suspension 0.5% post ab externo canaloplasty with or without cataract surgery, a small percentage of patients (5.3%) had an IOP ≥30 mm Hg one week post-surgery, but rarely thereafter and there were no treatment discontinuations secondary to IOP elevations 36…”

“…Although LE gel has not been studied in MIGS procedures specifically, three retrospective chart reviews have evaluated the use of LE suspension 0.5% in patients undergoing non-MIGS procedures for glaucoma 18,36,37. In patients following combined phacoemulsification and trabecular micro-bypass stent implantation, treatment with LE suspension 0.5% had a minimal effect on IOP 18.…”

“…To date, three retrospective chart reviews have been published describing the use of LE suspension 0.5% in patients undergoing glaucoma surgery, all of which reported that postoperative treatment with LE 0.5% had a minimal or no effect on IOP following ab externo canaloplasty,36 selective laser trabeculoplasty (SLT),37 and trabecular micro-bypass stent18 procedures. However, currently, there are no published clinical data addressing the use of LE gel 0.5% specifically in patients undergoing glaucoma surgery.…”