Loteprednol Etabonate 0.5% Gel Vs. Prednisolone Acetate 1% Solution After Descemet Membrane Endothelial Keratoplasty

Price, Marianne O.; Feng, Matthew T.; Scanameo, Amanda; Price, Francis W.

doi:10.1097/ico.0000000000000475

Cited by 72 publications

(56 citation statements)

References 20 publications

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“…One study reports that, within the first year after DMEK, loteprednol etabonate 0.5% gel was as effective as prednisolone acetate 1% in preventing immunologic rejection episodes, and that loteprednol reduced the risk of IOP elevation significantly. 12 None of the agents in our study indicated an IOP increase; but this finding can be explained by the fact that follow-up period in our study was the short time of 1 month. IOP increasing effect in topical corticosteroid use starts in 3-6 weeks in most cases, and recurs in 2-4 weeks after the medication is discontinued.…”

Section: Discussioncontrasting

confidence: 46%

Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone?

Koçluk

Sukgen

Cevher

et al. 2016

Ocular Immunology and Inflammation

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Section: Discussioncontrasting

confidence: 46%

Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone?

Koçluk

Sukgen

Cevher

et al. 2016

Ocular Immunology and Inflammation

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“…To manage IOP, glaucoma medications were initiated in 18% of patients and topical glucocorticoids were reduced earlier than planned in 22% of patients (Vajaranant et al, 2009). In 2 subsequent prospective studies, DMEK patients were treated with prednisolone acetate 1% qid for 1 month and then 325 eyes were randomized to remain on prednisolone or switch to fluorometholone 0.1% (FML®, Allergan Pharmaceuticals, Republic of Ireland) and 233 eyes were randomized to remain on prednisolone or switch to loteprednol etabonate 0.5% gel (dosing: tid for months 2 and 3, bid month 4, and once daily months 5 through 12) (Price et al, 2015; Price et al, 2014). The incidence of ocular hypertension as defined above was 24%, 11% and 8% with prednisolone acetate 1%, loteprednol 0.5% gel, and fluorometholone 0.1% respectively (p=0.0005 for prednisolone vs. fluorometholone and p=0.013 for predinisolone vs. loteprednol), while the incidence of rejection episodes were 0%, 0% and 1.4% respectively (p=0.17 for prednisolone vs. fluorometholone and p=1 for prednisolone vs. loteprednol) (Price et al, 2015; Price et al, 2014).…”

Section: Current Clinical Perspectivementioning

confidence: 99%

“…In those without pre-existing glaucoma, the incidence of postoperative IOP elevation (defined as ≥ 10 mm Hg over the baseline preoperative IOP) was 18% in the prednisolone group vs. 4% in the loteprednol group (p=0.0045) (Price et al, 2015). Notably, the glucocorticoid dosing was tapered more quickly in the latter 2 prospective studies than it was in the initial retrospective study (Price et al, 2015; Price et al, 2014; Vajaranant et al, 2009); a smaller proportion of patients exceeded the defined IOP elevation threshold with the faster glucocorticoid taper. Importantly, the IOP elevation threshold was not reached until the 1-year exam in some patients (Price et al, 2015; Vajaranant et al, 2009).…”

Section: Current Clinical Perspectivementioning

confidence: 99%

“…Notably, the glucocorticoid dosing was tapered more quickly in the latter 2 prospective studies than it was in the initial retrospective study (Price et al, 2015; Price et al, 2014; Vajaranant et al, 2009); a smaller proportion of patients exceeded the defined IOP elevation threshold with the faster glucocorticoid taper. Importantly, the IOP elevation threshold was not reached until the 1-year exam in some patients (Price et al, 2015; Vajaranant et al, 2009). Thus this series of studies clearly illustrate how the response to glucocorticoids depends upon the glucocorticoid potency, formulation (which influences ocular penetration), dosing frequency, and duration of exposure.…”

Section: Current Clinical Perspectivementioning

confidence: 99%

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Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Fini

Schwartz

Gao

et al. 2017

Progress in Retinal and Eye Research

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126

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Elevation of intraocular pressure (IOP) due to therapeutic use of glucocorticoids is called steroid-induced ocular hypertension (SIOH); this can lead to steroid-induced glaucoma (SIG). Glucocorticoids initiate signaling cascades ultimately affecting expression of hundreds of genes; this provides the potential for a highly personalized pharmacological response. Studies attempting to define genetic risk factors were undertaken early in the history of glucocorticoid use, however scientific tools available at that time were limited and progress stalled. In contrast, significant advances were made over the ensuing years in defining disease pathophysiology. As the genomics age emerged, it appeared the time was right to renew investigation into genetics. Pharmacogenomics is an unbiased discovery approach, not requiring an underlying hypothesis, and provides a way to pinpoint clinically significant genes and pathways that could not have been discovered any other way. Results of the first genome-wide association study to identify polymorphisms associated with SIOH, and follow-up on two novel genes linked to the disorder, GPR158 and HCG22, is discussed in the second half of the article. However, knowledge of genetic variants determining response to steroids in the eye also has value in its own right as a predictive and diagnostic tool. This article concludes with a discussion of how the Precision Medicine Initiative®, announced by U.S. President Obama in his 2015 State of the Union address, is beginning to touch the practice of ophthalmology. It is argued that SIOH/SIG may provide one of the next opportunities for effective application of precision medicine.

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“…8, 9, 11–13 DMEK has been shown to have a significantly lower risk of immunological rejection than DSEK and PK, 14, 15 and requires less topical corticosteroid therapy postoperatively without a significant increase in the rejection rate. 16, 17 Thus, DMEK offers significant advantages over DSEK in patients whose vision is already limited by advanced glaucoma and whose intraocular pressure (IOP) control is challenging postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery

Aravena

Deng

2016

Cornea

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Purpose To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior trabeculectomy or drainage device. Methods This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into three groups: surgical treatment [ST] group, medical treatment [MT] group, and control group. Visual improvement, endothelial cell (EC) loss, and postoperative complications, including rejection, graft failure, and IOP elevation (≥ 25 mm Hg) were evaluated. Results The length of follow-up was 9.7±7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (p=0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1±8.1 and 9.2±6.3 lines, respectively) than in the control (4.8±5.6 lines, p<0.05). The mean time to BCVA was 2.9±2.8 months for the ST group, 4.7±5.3 months for the MT group, and 3.0±3.3 months for the control (P=0.75). EC loss was greater in the ST group (44.6±17.8%) than in the MT group (29.9±12.0%) and the control group (32.7±11.3%, P=0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative IOP elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P=0.04). There was no difference in the air injection rate among all groups (P=1.0). Conclusion DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.

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Loteprednol Etabonate 0.5% Gel Vs. Prednisolone Acetate 1% Solution After Descemet Membrane Endothelial Keratoplasty

Cited by 72 publications

References 20 publications

Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone?

Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone?

Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery

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