difluprednate and Postoperative-Complications

Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.. Systematic review and meta-analysis.. Medline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references' lists of the relevant articles.. Randomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.. Two independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.. We included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).. With low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.

Topics: Animals; Anti-Inflammatory Agents; Cataract Extraction; Fluprednisolone; Humans; Postoperative Care; Postoperative Complications; Prednisolone

To establish whether difluprednate 0.05% nanoemulsion (DIFL) twice a day is as effective as prednisolone acetate 1% + phenylephrine hydrochloride 0.12% suspension (PRED) 4 times a day for postsurgical inflammation treatment.. 4 private Argentine ophthalmological centers.. Noninferiority, prospective, multicenter, double-blind, randomized, parallel-group, comparative trial.. A total of 259 patients who underwent phacoemulsification randomly received DIFL or PRED, starting the day before surgery and continuing for 28 days. The primary endpoint was central corneal thickness. Noninferior anti-inflammatory efficacy was considered if the difference of corneal thickness between baseline and day 4 did not differ beyond 17 μm between treatments. Secondary endpoints were cell and flare, corrected distance visual acuity (CDVA), endothelial cell count, optical coherence tomography (OCT) central macular thickness, and intraocular pressure. All outcomes were evaluated at baseline and day 1, 4, and 28 postoperatively.. 225 patients finished the study. The difference in corneal thickness at baseline and day 4 did not differ beyond 17 μm between treatments (95% CI -2.78 μm to 14.84 μm), with no statistically significant difference ( P = .523). No statistically significant differences were found between groups in total anterior chamber clearance at any study timepoint ( P > .05). Moreover, no statistically significant differences were reported between treatments in CDVA ( P = .455), endothelial cell count ( P = .811), OCT central macular thickness ( P = .869), and intraocular pressure outcome ( P = .316).. Difluprednate administered twice a day was at least as effective as prednisolone acetate administered 4 times a day for inflammatory treatment after cataract surgery.

Topics: Cataract; Eye Diseases; Fluprednisolone; Humans; Inflammation; Phacoemulsification; Postoperative Complications; Prednisolone; Prospective Studies

To assess the efficacy and safety of difluprednate ophthalmic emulsion 0.05% (Durezol) 2 or 4 times a day compared with those of a placebo in the treatment of inflammation and pain associated with ocular surgery.. Twenty-six clinics in the United States.. One day after unilateral ocular surgery, patients who had an anterior chamber cell grade of 2 or higher (>10 cells) were treated with 1 drop of difluprednate 2 times or 4 times a day or with a placebo (vehicle) 2 times or 4 times a day in the study eye for 14 days. This was followed by a 14-day tapering period and a 7-day safety evaluation. Outcome measures included cleared anterior chamber inflammation (grade 0, or=10 mm Hg and >or=21 mm Hg from baseline, respectively) versus 1% in the placebo group.. Difluprednate given 2 or 4 times a day cleared postoperative inflammation and reduced pain rapidly and effectively. There were no serious ocular adverse events. Fewer adverse events were reported in the difluprednate-treated groups than in the placebo group.

Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Cell Count; Double-Blind Method; Emulsions; Female; Fluprednisolone; Glucocorticoids; Humans; Inflammation; Male; Middle Aged; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Pain; Postoperative Complications; Uveitis, Anterior

To compare the outcomes and complications of topical difluprednate 0.05% and loteprednol gel 0.5% after routine cataract surgery.. Subjects received either difluprednate emulsion 0.05% (n=30 eyes) or loteprednol gel 0.5% (n=30 eyes) after routine cataract surgery. Topical steroid drops were initiated 3 days before cataract surgery and continued for 2 weeks postoperatively. Anterior chamber (AC) cell grade, corneal edema, corneal pachymetry, visual acuity, ocular surface quality (Oxford scale), and intraocular pressure (IOP) were evaluated at 1 day, 1 week, and 1 month postoperatively.. Patients treated with difluprednate or loteprednol had statistically similar resolution of their AC cell grade and corneal edema at 1 day, 1 week, and 1 month postoperatively (P>0.05 at each study visit). Difluprednate-treated and loteprednol-treated eyes achieved a mean best-corrected visual acuity of at least 20/25 by 1 week postoperatively (0.055 and 0.061 logarithm of the minimum angle of resolution, respectively; P=0.82). The nasal ocular surface quality at 1 week had improved in loteprednol-treated eyes compared with difluprednate-treated eyes (1.0 vs. 1.9 Oxford score, respectively; P<0.001), but similar at all other visits. There was no statistical difference between IOP levels between both treatment groups (P>0.05). In the difluprednate-treated group, one patient developed rebound inflammation and two patients developed cystoid macular edema at their 1-month postoperative visit.. The anti-inflammatory effect, visual recovery, and IOP of patients using topical difluprednate or loteprednol gel after cataract surgery are equivalent. There may be an additional short-term benefit of loteprednol gel in protecting the ocular surface after cataract surgery.

Topics: Aged; Aged, 80 and over; Anterior Chamber; Anti-Inflammatory Agents; Cataract Extraction; Cornea; Corneal Edema; Eye Diseases; Female; Fluprednisolone; Gels; Glucocorticoids; Humans; Inflammation; Intraocular Pressure; Loteprednol Etabonate; Male; Middle Aged; Postoperative Complications; Visual Acuity

Implantable collamer lenses (ICL) have gained popularity for correction of myopia where kerato-refractive procedures are not indicated as in cases of high myopic refractive errors. Toxic anterior segment syndrome (TASS) is a very uncommonly reported postoperative complication following ICL implantation. A young patient developed severe corneal oedema and anterior segment inflammation on the first day after ICL implantation. Analysing retrospectively, possible idiosyncratic response to intracameral pilocarpine was considered as a cause for TASS. Prompt and intensive therapy with oral and topical potent steroids was visually rewarding. TASS, though a sterile inflammation can have catastrophic sequelae such as corneal decompensation and secondary glaucoma. Hence, timely identification and management is important.

Topics: Adult; Anterior Eye Segment; Diagnosis, Differential; Endophthalmitis; Female; Fluprednisolone; Glucocorticoids; Humans; Lens Implantation, Intraocular; Myopia; Ophthalmic Solutions; Phakic Intraocular Lenses; Postoperative Complications

To compare intraocular pressure (IOP) outcomes between 2 common, commercially available corticosteroid drops: difluprednate ophthalmic emulsion 0.05% and prednisolone acetate 1.0%.. TLC Eyecare and Laser Centers, Jackson, Michigan, USA.. Retrospective chart review.. The outcomes of consecutive patients who had uneventful cataract surgery from April 2013 to September 2013 and used prednisolone acetate postoperatively were compared with the outcomes of consecutive patients who had uneventful cataract surgery from June 2014 to October 2014 and used difluprednate postoperatively.. The study included 224 eyes treated with prednisolone acetate 4 times daily for 30 days and 225 eyes treated with difluprednate 2 times daily for 30 days. There was no significant difference between the 2 groups in age, sex, or race. In addition, the mean IOP did not differ significantly between the prednisolone acetate group and the difluprednate group at the preoperative measurement or 1 month after surgery, nor was there a difference in the 1-month change in IOP between groups. No association was found between the incidence of a 6 mm Hg or higher increase in IOP 1 month after surgery and steroid treatment. One month postoperatively, 4 eyes in the prednisolone acetate group and 5 eyes in the difluprednate group had an IOP higher than 21 mm Hg.. There was no significant difference in the mean IOP or percentages showing IOP elevation between eyes treated with difluprednate and eyes treated with prednisolone acetate after cataract surgery. This was likely the result of low-frequency dosing and short duration of steroid use.

Topics: Cataract Extraction; Fluprednisolone; Glucocorticoids; Humans; Incidence; Intraocular Pressure; Ocular Hypertension; Postoperative Complications; Prednisolone; Tonometry, Ocular

Cataract is any opacification in lens or its capsule, which accounts for about 50% of treatable blindness worldwide. The prevalence of cataract in India is about 62.6%. The incidence of post operative endophthalmitis ranges from 0.05% - 0.14% and so the use of post-operative antibiotics and steroids is necessary to control infection and prevent inflammation. Fixed drug combinations not only cut the cost but also the dosage and improve the compliance of patients in the immediate post operative period. In this regard, the present study was conducted with the aim of studying the efficacy of using fixed drug combination (Difluprednate and Moxifloxacin) in reducing ocular inflammation and pain in post-operative patients undergoing cataract surgery.. Study design: Prospective interventional study, in which 749 eyes underwent SICS with IOL. All of them were treated with Difluprednate and Moxifloxacin, combination eye drops postoperatively 4 times a day, and reviewed on day 1, 5 and once in two weeks up to 6 weeks.. Out of 749 eyes, 730 were normal, 10 eyes had minimal raise in IOP in the range of 21 mmHg-31mmHg (considering 21mmHg as baseline) which decreased without any intervention within 3 weeks and only 9 eyes had raise in IOP of more than 31mmHg, which did not decrease in spite of discontinuing the drops and needed anti-glaucoma treatment.. Our study clearly shows that fixed drug combination of antibiotic and steroid does not cause raised IOP in about 97% of cases of SICS in the post-operative period and also improves the compliance of the patients.

Topics: Anti-Bacterial Agents; Cataract Extraction; Dose-Response Relationship, Drug; Drug Combinations; Endophthalmitis; Female; Fluprednisolone; Follow-Up Studies; Glucocorticoids; Humans; Incidence; India; Intraocular Pressure; Male; Moxifloxacin; Ophthalmic Solutions; Postoperative Care; Postoperative Complications; Prospective Studies; Tertiary Care Centers

Topics: Anti-Inflammatory Agents; Cataract; Cataract Extraction; Child; Double-Blind Method; Fluprednisolone; Humans; Inflammation; Ophthalmic Solutions; Postoperative Complications; Prednisolone

Topics: Anti-Inflammatory Agents; Cataract; Cataract Extraction; Child; Double-Blind Method; Fluprednisolone; Humans; Inflammation; Ophthalmic Solutions; Postoperative Complications; Prednisolone

To evaluate the effects of graft rejection episodes after Descemet's stripping automated endothelial keratoplasty surgery (DSAEK) on long-term endothelial cell density (ECD) decline and graft survival.. Retrospective, comparative analysis of an interventional case series.. We included 615 eyes of 415 Fuchs' dystrophy patients at a single institution with ≥ 6 months follow-up and without comorbidities known to influence postoperative ECD. All patients were enrolled as part of an ongoing, institutional review board-approved clinical protocol for a long-term, prospective study of endothelial keratoplasty in patients with endothelial dysfunction.. Preoperative specular microscopy of donor corneal tissue was performed. Postoperative specular microscopy measurements were recorded at 6 and 12 months, and yearly thereafter. The percentages of endothelial cell loss recorded at 1, 2, 3, and 4 years were compared with the Mann-Whitney U test.. Percentage ECD declines were calculated at each time point from the results of the preoperative and postoperative specular microscopy. Patients with graft rejection episodes and late endothelial failure were identified. Graft rejection was defined as findings of keratic precipitates with or without corneal edema, or anterior chamber cell and flare with or without corneal edema after the initial resolution of perioperative inflammation.. We identified 45 cases of graft rejection. The greatest number of rejections occurred between postoperative months 12 and 18. Eyes with a graft rejection episode had a higher median percentage decline in ECD at all time points compared with eyes without graft rejection episodes. This was statistically significant at 2 and 3 years postoperatively.. There is a trend toward a greater percentage of ECD loss with time in eyes experiencing graft rejection after DSAEK surgery.. Proprietary or commercial disclosure may be found after the references.

Topics: Aged; Cell Count; Corneal Endothelial Cell Loss; Descemet Stripping Endothelial Keratoplasty; Endothelium, Corneal; Female; Fluprednisolone; Follow-Up Studies; Fuchs' Endothelial Dystrophy; Glucocorticoids; Graft Rejection; Graft Survival; Humans; Male; Postoperative Complications; Prednisolone; Retrospective Studies; Time Factors

To present a case of unilateral hypopyon uveitis that began 15 days after uneventful bilateral LASIK in a 24-year-old man with an undisclosed history of ulcerative colitis.. Case report.. The hypopyon uveitis completely resolved after treatment with aggressive topical and oral steroid agents in combination with topical antibiotic coverage.. Although rare, visually significant hypopyon uveitis may arise after LASIK in the setting of ulcerative colitis and positive human leukocyte antigen (HLA) B27. Early recognition and treatment can result in an excellent outcome. The exact relationship between hypopyon uveitis and LASIK is impossible to ascertain.

Topics: Administration, Oral; Administration, Topical; Astigmatism; Colitis, Ulcerative; Fluprednisolone; Glucocorticoids; Granuloma; Humans; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Myopia; Postoperative Complications; Prednisone; Tomography, Optical Coherence; Uveitis, Anterior; Young Adult