difluprednate and Uveitis

This review aims to cover the preoperative planning, intraoperative considerations, and postoperative management that aids in successful outcomes of patients with cataract and uveitis. Disease-specific management and pediatric management will also be addressed.. Dexamethasone implants appear to be a safe and effective addition to standard steroid treatment in decreasing the incidence of postoperative cystoid macular edema (CME). Intravitreal steroids and topical difluprednate have shown utility in CME treatment.. Cataract surgery in eyes with uveitis is generally safe and effective if inflammation is well controlled; however, complication rates are still higher than in eyes without uveitis. Future investigations should delineate outcomes for eyes with different etiologies of uveitis, and further research is needed to adequately control inflammation and avoid postoperative complications.

Topics: Administration, Ophthalmic; Cataract; Cataract Extraction; Dexamethasone; Drug Implants; Fluprednisolone; Glucocorticoids; Humans; Intraoperative Care; Intravitreal Injections; Macular Edema; Postoperative Care; Preoperative Care; Uveitis; Visual Acuity

To evaluate the risk factors associated with clinically important intraocular pressure (IOP) elevation with topical difluprednate treatment in patients with non-infectious uveitis.. Retrospective cohort study.. Fifty-four eyes of 54 patients with non-infectious uveitis treated with topical difluprednate at the current institution were included. Demographics and clinical characteristics of uveitis patients were collected. The main outcome measure was development of clinically important IOP elevation defined as IOP ≥21 mmHg and an increase of ≥10 mmHg from baseline.. A clinically important IOP elevation was observed in 17 patients (31.5%). The mean time to clinically important IOP elevation was 7.4±4.8 weeks (range 3-19). Statistically significant risk factors for incident clinically important IOP elevation were being a child (adjusted hazard ratio [aHR] 7.85 [95% CI 1.48-41.56], P = .02) and concurrent use of systemic steroids (aHR 5.31 [95% CI 1.18-24.00], P = .03). Patients with concurrent systemic corticosteroids developed clinically important IOP elevation earlier than those without systemic corticosteroid (mean 5.7±3.4 [range 3-14] vs 10.4±5.7 [range 4-19] weeks, P = .05). Incident IOP ≥30 mmHg occurred in 7 patients (13.0%). All patients responded well to the cessation of difluprednate and/or use of topical antiglaucomatous agents and no eyes required glaucoma surgery.. This study demonstrated that clinically important IOP elevation is common in uveitis patients with topical difluprednate treatment. Children and patients with concurrent systemic corticosteroids are at substantial risk of developing clinically important IOP elevation.

Topics: Child; Fluprednisolone; Glaucoma; Glucocorticoids; Humans; Intraocular Pressure; Retrospective Studies; Uveitis

To describe clinical outcomes associated with the use of topical difluprednate in treating uveitic cystoid macular edema.. Retrospective, interventional case series.. Setting: Medical record review in a tertiary care uveitis center.. Fifty-eight patients (72 eyes) with uveitic cystoid macular edema (CME) treated with difluprednate 0.05% ophthalmic solution between June 2012 and May 2016.. Macular central subfield thickness (CST) determined by optical coherence tomography, improvement of CME (≥20% reduction in CST or resolution), and resolution of CME (CST ≤ 320 μm with no cysts) at 30 days after starting treatment. Outcomes were assessed up to 90 days.. CST on average decreased by 17% (95% CI: -33%, -7%) for eyes using only difluprednate (n = 43) and by 6% (95% CI: -17%, -2%) for eyes in patients using concomitant systemic immunosuppressive therapy (n = 29) at 30 days, a 12% difference between groups (95% CI: 2%, 21%, P = .02). Of eyes on difluprednate alone, 76% had improvement and 48% had resolution of CME. In patients using systemic therapy, 37% of eyes had improvement and 17% had resolution. Eight eyes (11%) had an intraocular pressure (IOP) > 24 mm Hg within the first 30 days. By 90 days, CME had improved in 69% of all eyes and resolved in 43% of eyes, with only 9 patients starting or increasing systemic immunosuppressive medications and 2 patients receiving periocular corticosteroid injections.. Difluprednate was associated with an improvement in uveitic CME and could be a reasonable first-line therapy. IOP should be closely monitored.

Topics: Adult; Aged; Dose-Response Relationship, Drug; Female; Fluprednisolone; Follow-Up Studies; Humans; Macula Lutea; Macular Edema; Male; Middle Aged; Ophthalmic Solutions; Retrospective Studies; Tomography, Optical Coherence; Treatment Outcome; Uveitis; Visual Acuity

Topics: Aged; Anastrozole; Aromatase Inhibitors; Breast Neoplasms; Carcinoma, Lobular; Female; Fluorescein Angiography; Fluprednisolone; Glucocorticoids; Humans; Macular Edema; Receptor, ErbB-2; Tomography, Optical Coherence; Uveitis

To evaluate the short-term safety and efficacy of topical difluprednate (0.05%) for the treatment of noninfectious uveitic cystoid macular edema.. Twenty-seven patients (35 eyes) undergoing treatment with difluprednate 4 times daily for 3 weeks for noninfectious uveitic cystoid macular edema were reviewed for visual acuity, intraocular pressure, optical coherence tomography, and fluorescein angiography results. A mixed model analysis was fit with each measure as the outcome, visit as the primary predictor, and patient and eye as random effects.. Mean central foveal thickness decreased by 117 μm (P < 0.001) at 30 ± 15 days, 124 μm (P < 0.001) at 60 ± 15 days, and 152 μm (P < 0.001) at 180 ± 30 days. Complete resolution of intraretinal fluid was observed in 15 of 34 (44%) eyes at 30 ± 15 days, 11 of 21 (52%) eyes at 60 ± 15 days, and 9 of 12 (75%) eyes at 180 ± 30 days. Improvement in fluorescein leakage was noted in 7 of 8 eyes (88%). Visual acuity improved by a mean of 5 letters (P = 0.001) at 30 ± 15 days, 5.5 letters (P = 0.007) at 60 ± 15 days, and 7 letters (P = 0.032) at 180 ± 30 days. Mean increase in intraocular pressure was 1.48 mmHg at 30 ± 15 days (P = 0.080), 1.92 mmHg at 60 ± 15 days (P = 0.110), and 6.18 mmHg (P = 0.001) at 180 ± 30 days.. Topical difluprednate is a well-tolerated and effective treatment for noninfectious uveitic cystoid macular edema with decreased central foveal thickness, mild improvement in visual acuity, and elevation of intraocular pressure observed in a few patients.

Topics: Administration, Topical; Adult; Aged; Female; Fluorescein Angiography; Fluprednisolone; Glucocorticoids; Humans; Intraocular Pressure; Macular Edema; Male; Middle Aged; Ophthalmic Solutions; Outcome Assessment, Health Care; Retrospective Studies; Tomography, Optical Coherence; Uveitis; Visual Acuity

To describe the clinical course of uveitis-associated inflammatory papillitis and evaluate the utility and reproducibility of optic nerve spectral domain optical coherence tomography (SD-OCT).. Data on 22 eyes of 14 patients with uveitis-related papillitis and optic nerve imaging were reviewed. SD-OCT measure reproducibility was determined and parameters were compared in active vs. inactive uveitis.. Papillitis resolution lagged behind uveitis resolution in three patients. For SD-OCT measures, the intraclass correlation coefficients were 99.1-100% and 86.9-100% for intraobserver and interobserver reproducibility, respectively. All SD-OCT optic nerve measures except inferior and nasal peripapillary retinal thicknesses were significantly higher in active vs. inactive uveitis after correction for multiple hypotheses testing. Mean optic nerve central thickness decreased from 545.1 to 362.9 µm (p = 0.01).. Resolution of inflammatory papillitis can lag behind resolution of uveitis. SD-OCT assessment of papillitis is reproducible and correlates with presence vs. resolution of uveitis.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Drug Monitoring; Female; Fluprednisolone; Glucocorticoids; Humans; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Nerve Fibers; Observer Variation; Ophthalmic Solutions; Optic Disk; Optic Nerve; Papilledema; Reproducibility of Results; Retinal Ganglion Cells; Retrospective Studies; Tomography, Optical Coherence; Triamcinolone Acetonide; Uveitis

To report a case of lamotrigine-induced tubulointerstitial nephritis and uveitis (TINU)-atypical Cogan syndrome.. Case report.. A 16-year-old boy with traumatic brain injury and seizures presented to the emergency department with facial swelling, rash, and back pain several days after increasing lamotrigine dose secondary to a breakthrough seizure. Creatinine, urine β2 microglobulin, and eosinophils were elevated. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, angiotensin-converting enzyme, and complement were normal. Renal biopsy showed acute granulomatous tubulointerstitial nephritis. Lamotrigine was discontinued, intravenous steroids were initiated, and the patient was discharged on Ativan and prednisone. Subsequently, he was diagnosed with bilateral anterior uveitis (vision 20/30 bilaterally) and started on prednisolone and cyclopentolate. Two months later, he developed a branch retinal artery occlusion in the right eye (vision 20/70) and bilateral ocular hypertension for which timolol-brimonidine and dorzolamide were added. Neuroimaging and hypercoagulability workup was unremarkable. Vision and intraocular pressure improved, while uveitis remained recalcitrant. Several months later, the patient developed central serous retinopathy in the right eye (vision 20/30). Prednisone was stopped but restarted due to methotrexate intolerance. A month later, he reported dizziness and was diagnosed with severe bilateral sensorineural hearing loss. Brain magnetic resonance imaging showed foci of perivascular, subcortical, and cochlear enhancement. Transtympanic Decadron injections and infliximab infusions were initiated. At the final visit, vision remained at 20/30 with trace anterior chamber reaction bilaterally while on timolol-brimonidine, dorzolamide, and prednisolone.. An idiosyncratic drug reaction should be considered in the differential diagnosis of TINU-atypical Cogan syndrome.

Topics: Adolescent; Anticonvulsants; Cogan Syndrome; Diagnosis, Differential; Drug Therapy, Combination; Fluprednisolone; Glucocorticoids; Humans; Lamotrigine; Magnetic Resonance Angiography; Male; Nephritis, Interstitial; Prednisolone; Prednisone; Tomography, Optical Coherence; Triazines; Uveitis

To evaluate the clinical effect of topical difluprednate in pediatric patients for treatment of noninfectious uveitis.. Retrospective, observational case series.. Twenty-six eyes of 14 pediatric patients with noninfectious uveitis who were treated with topical difluprednate were evaluated. Anterior and posterior cell grade, visual acuity, intraocular pressure (IOP), and cystoid macular edema (CME) were recorded at each visit. Main outcome measures were changes in anterior segment cell, CME, visual acuity, and IOP and development of a visually significant cataract.. A significant (≥ 2-grade decrease or decrease to 0 in anterior segment cell) reduction in anterior segment inflammation was observed during treatment with topical difluprednate in 88% of eyes (22/25) when used as an adjuvant to systemic immunomodulatory therapy. In addition, improvement in CME associated with uveitis was seen in response to topical therapy with difluprednate in 78% of eyes with CME (7/9). A significant IOP response (IOP increase of ≥ 10 mm Hg from baseline and IOP ≥ 24 mm Hg) was seen in 50% of eyes (13/26) and in 50% of patients (7/14); 3 eyes of 2 patients required glaucoma surgery. Cataract formation or progression was observed in 39% of eyes (10/26) and in 43% of patients (6/14); 5 eyes of 3 patients required cataract surgery.. Difluprednate is an effective agent for both control of anterior segment inflammation and reduction of CME in pediatric patients with uveitis when used as an adjuvant to systemic immunomodulatory therapy. A high rate of steroid-induced IOP elevation and cataract formation is seen in this population. Close monitoring of pediatric patients receiving difluprednate is recommended.

Topics: Administration, Topical; Adolescent; Aqueous Humor; Cataract; Child; Female; Fluprednisolone; Glucocorticoids; Humans; Intraocular Pressure; Macular Edema; Male; Ocular Hypertension; Ophthalmic Solutions; Retrospective Studies; Treatment Outcome; Uveitis; Visual Acuity

Topics: Administration, Topical; Adolescent; Adult; Child; Fluprednisolone; Glucocorticoids; Humans; Intraocular Pressure; Middle Aged; Ocular Hypertension; Uveitis; Young Adult

Topics: Adrenergic Uptake Inhibitors; Angioedemas, Hereditary; Benzoates; Carrier Proteins; Complement C1 Inactivator Proteins; Complement C1 Inhibitor Protein; Drug Approval; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Fluprednisolone; Humans; Huntington Disease; Hydrazines; Keratitis; Nurse's Role; Ophthalmologic Surgical Procedures; Pain, Postoperative; Purpura, Thrombocytopenic, Idiopathic; Pyrazoles; Pyridines; Receptors, Fc; Recombinant Fusion Proteins; Tetrabenazine; Thrombopoietin; Uveitis