Difluprednate for the Treatment of Uveitic Cystoid Macular Edema

Abstract

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 ≤ 320μm with no cysts) at 30days after starting treatment. Outcomes were assessed up to 90days. 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 30days, 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) > 24mm Hg within the first 30days. By 90days, 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.