Prednisolone Acetate Eye Drops Research Articles

Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies

Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as awhole organ but also the life of the patient due to its systemic cause. Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. 8patients with 14eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent apars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1patient received parabulbar administration of atriamcinolone depot in both eyes, 7patients received adexamethasone depot in 11eyes and all 8patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2logMar to 1.0logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2patients died from one of the underlying diseases after 3 and 25months, respectively. Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.

Ocular surface parameter changes in the untreated fellow eye after unilateral cataract surgery with short-term administration of anti-inflammatory eye drops

This study aimed to investigate the changes in clinical parameters of dry eye disease and meibomian gland dysfunction in both the operated and untreated fellow eyes of patients who underwent unilateral cataract surgery with the short-term administration of anti-inflammatory eye drops in the surgical eye. The medical charts of 57 consecutive patients who underwent unilateral cataract surgery and received 1% prednisolone acetate and non-steroidal anti-inflammatory drug (NSAID, 0.1% bromfenac sodium) eye drops were reviewed. The preoperative ocular surface disease index questionnaire score (38.9 ± 20.5) decreased significantly to 15.2 ± 16.4 at post-surgical 1 week and further to 12.8 ± 11.4 after 1 month. Although meibum quality grade increased and corneal sensitivity decreased at 1 week in operated eyes, corneal erosion scores and Sjogren’s International Collaborative Clinical Alliance ocular staining scores even improved over a month in the untreated fellow eyes. The tear matrix metalloproteinase (MMP)-9 grade decreased in both operated eyes and untreated fellow eyes after 1 month from surgery. In conclusion, the short-term topical anti-inflammatory treatment using steroid and NSAID eye drops in the operated eye after cataract surgery decreased subjective ocular surface discomfort and improved ocular surface staining scores and tear MMP-9 expression in the untreated fellow eyes.

Good Syndrome: Cytomegalovirus retinitis case challenge.

To describe cytomegalovirus retinitis in a patient with Good syndrome (hypogammaglobulinemia and thymoma), ocular progression despite treatment, and fatal outcome. A 71-year-old woman with unilateral panuveitis of unknown cause and a history of thymoma resection was referred to our clinic. Visual acuity (VA) was 20/100 in her right eye (OD) and light perception in her left eye (OS). In slit-lamp examination, OD had inferior fine pigmented keratic precipitates, 2+ anterior chamber (AC) cells, cataract, and 2+ vitreous cells, no fundus detail, and normal ocular ultrasound. OS presented a white cataract, chronic hypotony, and increased choroidal thickness with calcifications. Laboratory evaluations were normal or negative for common causes of infection and inflammation. Prednisolone acetate eye drops were started, with improvement of AC inflammation. Cataract surgery was performed, reaching VA of 20/30. Two years later, VA had decreased and 2+ vitritis and retinitis were found. On clinical suspicion of masquerade syndrome, a vitrectomy biopsy was performed; pathology reported no data on ocular lymphoma. Leukopenia and lymphopenia were found: immunoglobulin levels, CD4 count, and viral load revealed systemic immunosuppression. The aqueous tap was positive for cytomegalovirus. Oral valganciclovir and intravitreal ganciclovir were initiated. In a patient with previous resection of thymoma and hypogammaglobulinemia, final diagnosis was Good syndrome, with CMVR being secondary to immunosuppression. Despite treatment, CMVR progressed and systemic deterioration resulted in mortal outcome. Good syndrome is an extremely rare disease and association with CMVR is uncommon. To our knowledge, only 14 cases exist in the literature.

New onset of acute uveitis following COVID‐19 vaccination

AbstractPurpose: This study reported 11 cases of new‐onset acute uveitis following coronavirus disease 2019 (COVID‐19) vaccination.Methods: This retrospective observational case study included 11 eyes from 11 patients with acute uveitis after COVID‐19 vaccination. We only included patients with new‐onset uveitis. Patients' medical records from January 2021 to January 2022 were reviewed.Results: The mean age of the participants was 51.81 years, and all patients demonstrated anterior chamber reaction with keratic precipitates in the affected eye. The mean duration between vaccination and uveitis was 8.27 days. Seven patients developed uveitis after receiving the second vaccination, and four developed uveitis after receiving the third vaccination. Five patients showed posterior synechiae and three patients showed hypopyon. After treatment with topical 1% prednisolone acetate eye drops and systemic prednisolone, inflammation was adequately controlled and quickly resolved.Conclusions: COVID‐19 vaccination with messenger RNA and viral vector vaccines may cause acute anterior uveitis. Although initially severe, the patients' uveitis responded well to steroid therapy, without visual impairment.

ODP131 Zoledronic acid and red eye

Abstract Introduction Zoledronic acid, used for treatment of osteoporosis, Paget's disease of the bone, hypercalcemia of malignancy etc. is a bisphosphonate known for its anti-resorptive effect. A common adverse reaction with this medication is mild to moderate flu-like symptoms, which is transient and attributed to an acute phase reaction post zoledronic acid infusion. [1] A less common adverse reaction is ocular inflammation, including uveitis, iritis and episcleritis. [1] The incidence of ocular inflammation is 0.2 - 0.8%. [2] Development of ocular symptoms have been reported to occur between 1 to 7 days post zoledronic acid infusion. [2] We report a case of acute unilateral episcleritis following zoledronic acid infusion for treatment of osteoporosis. Clinical case: A 58-year-old female with a past medical history significant for glaucoma and gastroesophageal reflux (GERD) presented for management of osteoporosis. She could not tolerate oral bisphosphonates due to gastrointestinal side effects. She was therefore switched to intravenous zoledronic acid therapy. On day 1 post zoledronic acid infusion of 5mg dose, she developed diffuse joint and muscle pain as well as right eye pain, redness, photophobia, blurred vision and tearing. As her ocular symptoms progressed by day 5 post zoledronic acid infusion, she presented urgently to ophthalmology clinic when she was diagnosed with episcleritis of the right eye secondary to the zoledronic acid infusion. Patient was started on prednisolone acetate eyedrops twice a day. Three days after starting the eyedrops, patient reported complete resolution of her ocular symptoms. Further treatment for osteoporosis with zoledronic acid was discontinued. Conclusion We present a case of right eye episcleritis occurring 24 hours post zoledronic acid infusion leading to significant ocular discomfort and concern for the patient. Ocular inflammation is an uncommon occurrence post zoledronic acid infusion, hence is not often discussed during routine patient counseling in regards to risks and benefits of this particular treatment. We therefore stress the need for both provider and patient awareness regarding this uncommon ocular side effect related to zoledronic acid use. It is important to inform the patient and educate providers about the possibility of this acute phase reaction occurring post treatment with zoledronic acid to aid in prompt diagnosis and treatment. Our patient responded well to treatment with prednisolone acetate ophthalmologic drops. A rechallenge with zoledronic acid has not been pursued.

New onset of acute uveitis following COVID-19 vaccination.

PurposeThis study reported 11 cases of new-onset acute uveitis following coronavirus disease 2019 (COVID-19) vaccination.MethodsThis retrospective observational case study included 11 eyes of 11 patients with acute uveitis after the COVID-19 vaccination. We only included patients with new-onset uveitis. The medical records of the patients from January 2021 to January 2022 were reviewed.ResultsThe mean age of the participants was 51.81 years, and all patients demonstrated anterior chamber reaction with keratic precipitates in the affected eye. The mean duration between vaccination and uveitis was 8.27 days. Seven patients developed uveitis after receiving the second dose of vaccination, and four developed uveitis after receiving the third dose of vaccination. Five patients showed posterior synechiae, and three patients showed hypopyon. After treatment with topical 1% prednisolone acetate eye drops and systemic prednisolone, inflammation was adequately controlled and quickly resolved.ConclusionsCOVID-19 vaccination with messenger RNA and viral vector vaccines may cause acute anterior uveitis. Although initially severe, uveitis responded well to steroid therapy with no visual impairment.

In Clinic Optometrist Insertion of Dextenza (Dexamethasone Ophthalmic Insert 0.4mg) Prior to Cataract Surgery: The PREPARE Study.

PurposeTo evaluate the clinical outcomes with optometrist pre-surgical insertion of dexamethasone ophthalmic insert 0.4mg in the clinical office setting in patients undergoing same-day cataract surgery compared to standard of care steroid therapy.MethodsIn this prospective, contralateral eye trial, one eye received a dexamethasone ophthalmic insert 0.4mg and the other received topical prednisolone acetate 1% four times per day for one week, then three times per day for one week, then two times per day for one week, and then one time per day for one week. At one day, seven days, and four weeks postoperatively mean anterior chamber cell score and mean anterior chamber flare score was assessed by Slit Lamp Biomicroscopy and pain score was assessed by Visual Analog Scale from 0–10. Incidence of increased intraocular pressure and cystoid macular edema were also assessed.ResultsThirty patients (60 eyes) participated. At one day postoperative there was no significant difference in mean anterior chamber cell score (p= 0.70) or pain score (p= 0.92). There was no anterior chamber cell flare observed in the study or control group. Of the 30 patients, 29 expressed a preference for dexamethasone inserts compared to topical prednisolone acetate. One patient in the study group had elevated intraocular pressure that resolved and there was no cystoid macular edema measured.ConclusionIn patients undergoing routine cataract surgery, there was an overwhelming preference for a dexamethasone insert compared to topical steroid drops. The dexamethasone insert produced similar ocular comfort and inflammation prevention compared to prednisolone acetate eyedrops. Dexamethasone inserts are a safe and effective treatment option for reducing pain and inflammation when inserted by an optometrist prior to routine cataract surgery.

A comparative study of the effect of topical 0.03% tacrolimus plus 1% topical prednisolone with 1% topical prednisolone alone in preventing rejection after penetrating keratoplasty

Immunologic corneal allograft rejection represents one of the main cause for graft failure. This study was conducted to observe and comparing the beneficial effect of topical 0.03% tacrolimus on corneal graft survival.To compare the effect of topical 0.03% tacrolimus plus 1% topical prednisolone with 1% topical prednisolone alone in preventing rejection after PK.40 patients were randomly allocated into two groups:Group A: patients received 0.03% topical tacrolimus ointment twice daily for a month plus 1% prednisolone acetate eye drops 2 hourly and tapered monthly. Group B: patients received 1% prednisolone acetate eye drop only 2 hourly and tapered monthly.The clinical outcomes were assessed in terms of post-op complications, graft rejection, and visual acuity after 6 months of follow-up. SPSS software, 20.0 version, IBM, Chicago were used for statistical analysis.Out of 40 patients, 29 (72.5%) were male and 11(27.5%) were female. Type of surgery and continuous suture closure was found to be statistically significant (p-value < 0.05) with post-op visual acuity in both groups. Types of graft rejection were found to be statistically significant (p-value < 0.05) with enucleation transplantation time(hours) in both groups and with secondary glaucoma (p = <0.001) in group A.We conclude that 0.03% topical tacrolimus ointment along with 1% topical prednisolone shows promising results and can be considered as an effective modality for preventing complications like secondary glaucoma, graft rejection, and getting the better visual outcome, where p-value (<0.05) was statistically significant.All patients should be instructed with regards to the reasonable use of topical tacrolimus to avoid any side effects.

Incidence and risk factors for postoperative intraocular pressure response to topical prednisolone eye drops in patients undergoing phacoemulsification.

To report the incidence, risk factors, and magnitude of steroid response in individuals receiving topical 1% prednisolone acetate eye drops following phacoemulsification surgery MATERIALS AND METHODS: Postoperative IOP of 1118 consecutive patients who had uneventful cataract surgery and used 1% topical prednisolone acetate were studied. Baseline ocular parameters like best-corrected visual acuity, IOP, and slit-lamp examination findings were noted preoperatively and at postoperative day 30. Incidence of postoperative intraocular pressure response to steroid was analyzed and graded as mild, moderate, or severe and risk factors studied. The mean age of our study cohort was 59.49 ± 7.25years. The overall incidence of steroid response was 3.2%, (2.8% being moderate responders, and 0.4% high responders). Mean preoperative IOP was 14.67 ± 2.2mm Hg in the study cohort (n = 1118). Mean postoperative IOP was 21.33 ± 7.97mm Hg in the steroid responder (SR) and 14.66 ± 2.8mm Hg in the non-responder (NR), with a statistically significant difference from the baseline IOP in the SR group (p < 0.001) and no difference in the NR. Univariate analysis revealed younger age and high axial length as risk factors but on multiple regression analysis, only younger age < 50years was found to be a significant risk factor for steroid response. The overall steroid response in this population post-cataract surgery was low with most being moderate responders. Younger age and higher axial length were identified as risk factors for steroid response, and hence this warrants the judicious use of steroids in such individuals.

Comparison between 0.1% Nepafenac and 1% Prednisolone Eye Drop in Postoperative Management Following Micro-incisional Cataract Surgery.

PurposeTo compare the efficacy of 0.1% nepafenac and 1% prednisolone acetate eye drop in postoperative inflammation control in micro-incisional cataract surgery.MethodsWe conducted a prospective, randomized, comparative, single-blind study. All the patients underwent temporal 2.2-mm micro-incisional cataract surgery. They were randomized into two groups (group A and B). Group A received 0.1% nepafenac eye drops 4 times/day for 4 weeks and group B received 1% prednisolone acetate eye drops in tapering doses for 4 weeks after surgery. Both the groups received moxifloxacin 0.5% eye drops 4 times/day for 2 weeks. Patients were examined on 1st, 7th, and 30th postoperative days and parameters of postoperative inflammation were evaluated and noted at each visit.ResultsA total of 200 patients were enrolled in the study. However, five patients lost to follow up, group A had 97 and group B had 98 patients respectively. Results were statistically insignificant in terms of the difference in lid edema, conjunctival congestion, corneal edema, anterior chamber cells and flare between the two groups with p-values >0.05 for each parameter at each visit. However, the difference in mean central macular thickness between the groups was significant (205.713 ± 17.14 vs. 220.984 ± 32.83 in group A and B, respectively, p ≤ 0.001) at 1 month. Also, the mean pain score was significantly lower (p = 0.018) in the nepafenac group at day 7 of surgery.ConclusionsNepafenac is equally effective and non-inferior to prednisolone acetate in suppression and prevention of inflammation in postoperative period.

The effect of loteprednol suspension eye drops after corneal transplantation

BackgroundTo compare the effect of loteprednol suspension eye drops after corneal transplantation with the effect of prednisolone acetate eye drops.MethodsA total of 234 patients (234 eyes) who underwent penetrating keratoplasty (PKP) and lamellar keratoplasty (LKP) were retrospectively included. Patients who received 1 % prednisolone acetate eye drops were defined as 1 % prednisolone acetate eye drop group (n = 96), and patients who received 0.5 % loteprednol suspension eye drops were defined as 0.5 % loteprednol suspension eye drop group (n = 138).Results35 cases in 1 % prednisolone acetate eye drops group and 27 cases in 0.5 % loteprednol suspension eye drops group developed corticosteroid-induced ocular hypertension, and were defined as prednisolone acetate group and loteprednol group. No significant differences were observed in the average intraocular pressure (IOP) at 1 week, 1 month, 3 months or 12 months postoperatively. There were significant differences in the average IOP between the two groups at 6 months postoperatively (P = 0.001). There were no significant differences in the average best corrected visual acuity (BCVA) at 1, 3 and 12 months postoperatively between two groups. The average 6-month postoperative BCVA was significantly higher in the prednisolone acetate group than the loteprednol group (P < 0.05). There were no significant differences in the postoperative graft rejection rates between the two groups (P > 0.05).Conclusions0.5 % loteprednol suspension eye drops may be considered for long-term use after corneal transplantation.

Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India

Background & Objectives: Comparative analysis of the post-operative anti-inflammatory effect of topical 0.1% dexamethasone sodium eye drops, topical 1% prednisolone acetate eye drops and difluprednate 0.05% topical eye drops after small incision cataract surgery at a tertiary eye care institute in India. Materials and Methods: The current study was a prospective randomised control study conducted from June 2019 to January 2021 at a tertiary eye care institute in India after taking due clearance from the institutional ethical committee. 300 eyes of 215 patients were enrolled into the study and divided into three groups consisting of 100 eyes in each group. Group A patients received topical Dexamethasone 0.1% eye drops, group B & C received Prednisolone acetate 1% and difluprednate 0.05% eye drops respectively. Level of significance was kept at p Results: Baseline IOP values between the three groups did not show any statistical significance. Significant difference in the analgesia was observed in the difluprednate 0.05% group. AC cells & flare was decreased by around the 7th day of treatment in difluprednate and prednisolone acetate eye drops treated groups. Conclusion: To conclude our study opines that, dexamethasone is non-inferior and equally efficacious to prednisolone and difluprednate in the management of post cataract surgery inflammation. Although difluprednate 0.05% provides superior analgesia and early clearance of AC cells & flare, which may further aid in early visual rehabilitation and recovery. Keywords: Difluprednate, Prednisolone, AC cells, Flare, IOP.

Correction: Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients - A Retrospective Cross-Sectional Observational Study.

Purpose To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) in Acanthamoeba keratitis (AK) patients. Patients and Methods In this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal. Results ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mm2) to the time point 3 months after surgery (1914 ± 164 cells/mm2; p = 0.080) and to the time point after the first suture removal (1886 ± 557 cells/mm2; p = 0.066) and decrease significantly to the time point after the second suture removal (1650 ± 446 cells/mm2; p = 0.028). CCT did not change significantly over the analyzed time period (p ≥ 0.475). Conclusion In AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.

Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients - A Retrospective Cross-Sectional Observational Study.

To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) in Acanthamoeba keratitis (AK) patients. In this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal. ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mm2) to the time point 3 months after surgery (1914 ± 164 cells/mm2; p = 0.080) and to the time point after the first suture removal (1886 ± 557 cells/mm2; p = 0.066) and decrease significantly to the time point after the second suture removal (1650 ± 446 cells/mm2; p = 0.028). CCT did not change significantly over the analyzed time period (p ≥ 0.475). In AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.

Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction

A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to <i>Mycobacterium leprae</i> (<i>M. leprae</i>) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.

Triamcinolone acetonide induces sterile endophthalmitis in patients with intermediate uveitis: A case report series.

Due to their anti-inflammatory, antiangiogenic and antiedematous properties, corticosteroids have been commonly used in the treatment of retinal diseases. Intravitreal administration of steroids offers the maximal drug efficacy and the lowest risk of systemic side effects. The authors report three cases of presumed sterile endophthalmitis induced by triamcinolone acetonide (TA) in three eyes with intermediate non-infectious uveitis. Each patient received a single intravitreal injection of TA of 4 mg. Because of the intense vitreous inflammatory reaction, retina examination and the optical coherence tomography could not be performed, although vitreous opacities were observed on the ocular ultrasound. The dense vitreous opacity is a defining factor, the anterior segment inflammation is mild to moderate and a hypopyon is present, which may be a sterile inflammatory reaction or the triamcinolone material itself. In cases of sterile endophthalmitis, the visual acuity increases progressively as the intraocular inflammation diminishes. Local treatment with topical antibiotics, prednisolone acetate and cycloplegic eyedrops is recommended to control the inflammatory reaction.

Safety and Efficacy of 0.1% Nepafenac versus 1% Prednisolone Acetate Eye Drops after Laser Peripheral Iridotomy: A Prospective, Randomized Trial

To compare 0.1% nepafenac, a topical nonsteroidal anti-inflammatory drop, with 1% prednisolone acetate in controlling inflammation after neodymium:yttrium-aluminum-garnet laser peripheral iridotomy (LPI) in primary angle-closure suspects (PACS). Randomized controlled trial. One hundred fifty-two PACS undergoing bilateral LPI. Patients were randomized to 0.1% nepafenac or 1% prednisolone acetate eye drops in both eyes. Medications were given 4 times daily for 7 days, then twice daily for additional 7 days. Investigators were masked to the type of medication. Right eyes in patients with bilateral PACS and the PACS eye in asymmetrical disease (primary angle closure in fellow eye) were analyzed. Noninferior control of inflammation, defined as absence of cell in the anterior chamber at 2 weeks and absence of rebound iritis with medication discontinuation, was the primary outcome, whereas difference in the rise in intraocular pressure (IOP) was a secondary outcome. Both groups were comparable in baseline characteristics, including IOP and total laser energy. Nepafenac was noninferior to prednisolone with regard to inflammation control, with 1 nepafenac-treated eye (1.3%) not meeting the primary end point because of 1+ anterior chamber cell at 2 weeks and 4 prednisolone-treated eyes (5.4%) failing to meet the primary end point because of rebound iritis (P < 0.001). A greater increase in IOP from baseline to 2 weeks was observed in the prednisolone group compared with the nepafenac group (+2.6 mmHg vs.+0.6 mmHg; P= 0.004), although at 4 weeks, IOP was not significantly different than baseline in either group (P > 0.05 for both). Two weeks after LPI, 3 nepafenac-treated eyes and 10 prednisolone-treated eyes demonstrated a 6- to 15-mmHg IOP elevation from baseline (P= 0.10), whereas 2 prednisolone-treated eyes and no nepafenac-treated eyes showed IOP elevation of more than 15 mmHg (P= 0.20). Four weeks after LPI, more prednisolone-treated eyes showed IOP elevation of 6 to 15 mmHg as compared with nepafenac-treated eyes (6 eyes vs. 1 eye; P= 0.04); no eyes showed IOP elevation of more than 15 mmHg. Nepafenac was noninferior to prednisolone in controlling inflammation after LPI in PACS.

Corneal deposition of fluoroquinolones after penetrating keratoplasty: case series.

Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administration post-penetrating keratoplasty.Case reports: Herein we report three patients ranging in age from 42–65 years who underwent keratoplasty with cataract extraction, with intraocular lens implantation in the first two cases and left aphakic due to a posterior capsular tear in the third case. The first two patients received ciprofloxacin-dexamethasone combination drops, and developed drug deposition, which was observed at the first follow-up after 7 and 10 days respectively. The third patient received prednisolone acetate and ofloxacin eyedrops postoperatively, and developed drug deposits in the cornea after 20 days. In all of the three patients, the fluroquinolone group of drugs was discontinued and the cornea cleared gradually over the next 3–4 weeks. Although the cornea cleared, the first two grafts failed due to recurrent viral infection in one case, and graft rejection in the other case.Conclusion: Deposition of many different fluroquinolones in the cornea has been reported after a variety of surgeries, including penetrating keratoplasty. Drug deposition post-penetrating keratoplasty may seem innocuous due to self-resolution on cessation of the drugs, but it may have deleterious effects on graft survival. Hence, fluroquinolones, especially ciprofloxacin, should be cautiously used in patients undergoing penetrating keratoplasty if frequent dosing is prescribed or if used concurrently with other topical medications containing preservatives.

Clinical features of glucocorticoid eye drops induced ocular hypertension in pediatric and adult uveitic eyes

Objective: To investigate the clinical features of glucocorticoid eye drops induced ocular hypertension in pediatric and adult uveitic eyes. Methods: Retrospective survey of consecutive uveitic patients attending referral service at Peking Union Medical College Hospital from March 2013 to August 2017. Incidences of glucocorticoid eye drops induced ocular hypertension were compared between the pediatric and adult uveitic groups. The clinical patterns of 1% prednisolone acetate eye drops induced ocular hypertension in pediatric and adult uveitic eyes were also investigated. Data were analyzed using the Mann-Whitney test and the χ(2) test. Results: The clinical data of 1 138 uveitic eyes [677 patients; 331 males and 346 females; mean age (31±16) years]receiving corticosteroid eye drops were reviewed, among which 246 eyes (143 patients) had pediatric uveitis and 892 eyes (534 patients) had adult uveitis. The incidence of glucocorticoid eye drops induced ocular hypertension was higher in pediatric eyes (39.8%, 98/246) as compared to adults (29.1%, 260/892) (χ(2)=9.880, P=0.002). One hundred and thirty eyes (75 patients) with 1% prednisolone acetate induced ocular hypertension were included in the clinical pattern analysis, including 49 [28 patients; 15 males and 13 females; mean age (11±3) years] pediatric and 81 [47 patients; 22 males and 25 females;mean age (34±12) years] adult uveitic eyes. No differences were found in daily doses of 1% prednisolone acetate between the pediatric group [4.60 (3.46, 5.36) drops/day] and the adult group [4.00 (3.30, 4.88) drops/day; Z=-1.675, P=0.094]. But the duration of medication in pediatric eyes [4.71 (2.79, 6.36) weeks] was significantly shorter as compared to the adults [6.00 (4.86, 9.00) weeks; Z=-3.446, P<0.001]. The intraocular pressure (IOP) was 26.00 (24.00, 31.00) mmHg (1 mmHg=0.133 kPa) in pediatric uveitic eyes and 26.00 (23.30, 31.15) mmHg in the adults, which showed no statistical significance (Z=-0.231,P=0.818). To achieve effective IOP control, 79.6% (39/49) of pediatric and 54.3% (44/81) of adult eyes received IOP-lowering drug therapy (χ(2)=8.447,P=0.004). And during the follow-up, the withdrawal rate of IOP-lowering drugs was much lower in pediatric eyes (48.7%, 19/39) as compared to the adult group (72.7%, 32/44) (χ(2)=5.031, P=0.025). Conclusion: Compared with adult patients with uveitis, children with uveitis are more prone to IOP elevation, which is more difficult to control after the use of glucocorticoid eye drops. (Chin J Ophthalmol, 2018, 54: 839-842).

Topical cyclosporine-A versus prednisolone for herpetic stromal keratitis: a randomized controlled trial.

To compare topical cyclosporine-A 2% eye drop (Cs-A) with prednisolone acetate 1% eye drop for treatment of herpetic stromal keratitis (HSK). In this randomized clinical trial, 38 eyes of 33 patients with HSK were randomly assigned to receive either 2% Cs-A or 1% prednisolone acetate eye drops. All subjects received oral acyclovir 400mg twice a day. Slit-lamp examination, Scheimpflug tomography corneal optical densitometry (Pentacam®, Oculus Inc., Wetzlar, Germany), best-corrected visual acuity (BCVA), and intra-ocular pressure (IOP) were evaluated at the first visit, and 14 and 30days after the treatment. Within-group analysis revealed significant improvement of total cornea optical density after 30days of treatment in both groups (30.3±10.5 to 28.3±9.8, p<0.001 for prednisolone group, and 30.5±8.8 to 28.8±8.3 p<0.001 for Cs-A group, mean±SD). We were not able to disclose any significant difference between the two groups regarding the improvement of cornea optical density (p=0.66). Best-corrected visual acuity (BCVA) logMAR significantly improved in both groups after 30days of treatment (0.20±0.52, p=0.002 in prednisolone group, and 0.24±0.31, p<0.001 in Cs-A group, mean±SD). Analysis between groups did not show a significant difference of BCVA improvement (p=0.45). We did not observe any severe side effect attributable to drugs. Cs-A 2% and prednisolone acetate 1% topical eye drops are effective for treatment of HSK.