Intraocular Pressure Response to Loteprednol Etabonate in Known Steroid Responders

Bartlett, Jimmy D.; Horwitz, Barry; Laibovitz, Robert; Howes, John F.

doi:10.1089/jop.1993.9.157

Cited by 86 publications

(64 citation statements)

References 11 publications

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“…35,36 Previous studies have confirmed the relatively lower risk of IOP elevation with LE compared with other ocular steroids, including studies in known steroid responders. [37][38][39][40][41][42][43][44][45] Limitations of this analysis included the lack of either a non-active control, or a control of a different drug category and the 2-week follow-up period. The study treatments both contained the same antibacterial (tobramycin), and a highly effective corticosteroid (loteprednol etabonate or dexamethasone).…”

Section: Discussionmentioning

confidence: 99%

Loteprednol Etabonate 0.5%/Tobramycin 0.3% Compared with Dexamethasone 0.1%/Tobramycin 0.3% for the Treatment of Blepharitis

Comstock¹,

DeCory²

2016

Ocular Immunology and Inflammation

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Section: Discussionmentioning

confidence: 99%

Loteprednol Etabonate 0.5%/Tobramycin 0.3% Compared with Dexamethasone 0.1%/Tobramycin 0.3% for the Treatment of Blepharitis

Comstock¹,

DeCory²

2016

Ocular Immunology and Inflammation

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“…The recent development of C-20 ester corticosteroids may warrant revision of the guidelines. C-20 ester corticosteroids, modelled by LE, are as effective as traditional corticosteroids but are significantly less likely to induce elevations in IOP (Bartlett et al 1993a;Asbell & Howes 1997;Friedlaender & Howes 1997 Ilyas et al 2004;Holland et al 2008;White et al 2008;Holland et al 2009), while the replacement of the ketone group at the C-20 position with an ester is expected to reduce the cataractogenic effects of these corticosteroids (Manabe et al 1984).…”

Section: Resultsmentioning

confidence: 99%

“…3) Specifically, LE is the 17b-chloromethyl ester of D1-cortienic acid etabonate, a derivative of the prednisolone metabolite D1-cortienic acid. This allows LE to be active at its site of action and subsequently undergo predictable hydrolysis to inactive carboxylic acid metabolites by naturally occurring ocular esterases, resulting in reduced side-effects of elevated IOP (Table 3) (Armaly 1965;Mindel et al 1980;Manabe et al 1984;Bartlett et al 1993a;Urban & Dreyer 1993;Leibowitz et al 1996;Ilyas et al 2004;Bodor & Buchwald 2005;Holland et al 2008;White et al 2008;Holland et al 2009). In addition, the C-20 ketone group on corticosteroids is associated with the formation of cataracts through the development of Schiff base intermediates via an interaction between the C-20 ketone group and lysine residues of proteins (Manabe et al 1984;Bodor & Buchwald 2005).…”

Section: ; Bielory 2008mentioning

confidence: 99%

Management of seasonal allergic conjunctivitis: guide to therapy

Bielory

O’Brien

Bielory

2011

Acta Ophthalmologica

104

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Abstract.Seasonal allergic conjunctivitis (SAC) is an inflammatory response of the conjunctiva triggered by exposure to seasonal allergens. Treatment options for SAC include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti‐inflammatory drugs, dual antihistamine/mast cell stabilizers, immunotherapy and corticosteroids. Topical, intranasal and systemic formulations of corticosteroids have traditionally provided the most effective relief of the inflammation and signs and symptoms associated with severe, acute exacerbations of SAC. However, steroid‐induced ocular and systemic side‐effects have limited the prescribing of these agents. This limitation of traditional corticosteroids led to the development of modified corticosteroids that retain the anti‐inflammatory mechanism of action of traditional corticosteroids with a much‐improved safety profile because of their rapid breakdown to inactive metabolites after exerting their activity. The development of one such novel corticosteroid, loteprednol etabonate (LE), led to the insertion of an ester (instead of a ketone) group at the carbon‐20 (C‐20) position of the basic corticosteroid structure. Clinical trials assessing this C‐20 ester corticosteroid have demonstrated similar efficacy to C‐20 ketone corticosteroids in the prevention or treatment of the signs and symptoms of SAC but with a greatly improved safety profile, as the C‐20 ester corticosteroid is less likely to elevate intraocular pressure. In addition, the ketone at the C‐20 position has been implicated in the formation of cataract, while nonketolic corticosteroids do not form Schiff base intermediates with lens proteins, which is a common first step in cataractogenesis. The clinical relevance of the C‐20 ester corticosteroid class, as modelled by LE, is that they provide both effective and safe treatment of the inflammation associated with SAC and relief of its signs and symptoms. Loteprednol etabonate offers a well‐tolerated treatment option for patients with debilitating acute exacerbations as well as chronic forms of the disease.

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“…O tratamento da inflamação a base de corticóide geralmente é muito eficaz, devendo ser associado e ter o seu desmame bem controlado. Optamos por substituir o colírio de acetato de prednisolona por etabonato de lotoprednol para o desmame do corticóide, pois existe menor chance de hipertensão cortisônica (39) . O desenvolvimento de sinais e sintomas relacionados com a disfunção lacrimal pode estar relacionado à presença de cloreto de benzalcônio como conservante nos colírios utilizados (40) .…”

Section: Discussionunclassified

Hipertensão ocular "mascarada" por edema de córnea após cirurgia da catarata

Valbon¹,

Guerra²,

Silva³

et al. 2009

Rev. bras.oftalmol.

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RESUMOCom base em modelos matemáticos e estudos experimentais estima-se que as medidas da PIO sejam linearmente hiperestimadas em córneas com maior espessura e menor ceratometria por meio de tonometria de aplanação de Goldmann (TAG). Entretanto, tal influência se dá de uma maneira mais complexa que a prevista por estes parâmetros geométricos, sendo diretamente relacionada com propriedades biomecânicas. O sistema de não contato ORA (Ocular response analyzer -Reichert) permite estudo das propriedades biomecânicas juntamente com a medida pressórica calibrada para a TAG e a compensada da córnea. Adicionalmente, o estudo tomográfico com reconstrução tridimensional do mapa paquimétrico caracteriza a córnea de forma mais completa que a ceratometria anterior e espessura central. Neste artigo, relatamos um caso de dor ocular, fotofobia e baixa visão, 28 dias após cirurgia de facoemulsificação com implante de lente intraocular sem complicações em paciente feminina de 81 anos. Na primeira visita da paciente, enquanto a TAG era de 16 mmHg, o valor da PIO compensada da córnea (PIOcc), obtido com o ORA, era 25,6 mmHg. A histerese e fator de resistência da córnea eram baixos, 4,1 e 6,1mmHg respectivamente, apesar da paquimetria central ser relativamente mais elevada, de 601 micra. O padrão de distribuição espacial da espessura era atenuado, compatível com edema corneano que era observado também por meio das imagens de Scheimpflug (Pentacam). Com base nestes dados, foi feito diagnóstico de quadro de uveíte hipertensiva, associado à edema corneano, instituindose tratamento tópico com combinação fixa de maleato de timolol e brimonidina associado ao acetato de prednisolona. Três semanas após, a paciente apresentou-se com grande melhora da acuidade visual, resolução do edema corneano, e dos sintomas, normalizando os parâmetros biomecânicos, geométricos da córnea e de PIO.

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Intraocular Pressure Response to Loteprednol Etabonate in Known Steroid Responders

Cited by 86 publications

References 11 publications

Loteprednol Etabonate 0.5%/Tobramycin 0.3% Compared with Dexamethasone 0.1%/Tobramycin 0.3% for the Treatment of Blepharitis

Loteprednol Etabonate 0.5%/Tobramycin 0.3% Compared with Dexamethasone 0.1%/Tobramycin 0.3% for the Treatment of Blepharitis

Management of seasonal allergic conjunctivitis: guide to therapy

Hipertensão ocular "mascarada" por edema de córnea após cirurgia da catarata

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