Topical Steroid Medication Research Articles

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction.

To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens-treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169-174.

Atypical presentation of incomplete Vogt-Koyanagi- Harada Syndrome (VKH) in 9-year-old boy

A 9-year-old boy presented with an episode of loss of consciousness associated with preceding persistent headache for a month with severe photophobia and redness for 15 days. He received treatment for probable meningitis. Ocular features include anterior uveitis, serous retinal detachment and disc hyperaemia. The diagnosis of incomplete Vogt–Koyanagi–Harada (VKH) was made, and he received systemic corticosteroids and azathioprine along with topical steroid medications. VKH can present with prolonged prodromal symptoms; we as ophthalmologists should be vigilant to recognize atypical variants of the disease, especially in the paediatric age group.

Unilateral blindness presumed as sudden acquired retinal degeneration syndrome (SARDS) in one Dachshund and four Maltese dogs.

To describe blindness, initially presenting as a unilateral condition and diagnosed as sudden acquired retinal degeneration syndrome (SARDS). One Dachshund and four Maltese dogs presented with unilateral blindness, for which the results of general ophthalmic examinations were insufficient to explain the blindness. All dogs were spayed females. Intraocular pressures were normal, and the optical media of the eyes were clear. Fundus appearances of the initially blind eyes were within normal variations, with slightly attenuated retinal blood vessels in some cases when compared with the sighted contralateral eyes. Electroretinography (ERG) amplitudes of the affected eyes were flat and reduced in the contralateral-sighted eyes in four dogs. One dog underwent ERG after the blindness progressed bilaterally 8 days after initial presentation (despite topical steroid medication). Two dogs had no recheck visits, but phone call follow-ups reported bilateral blindness 3 months later in one dog. One dog received no medication and retained vision in the contralateral eye until the last follow-up (94 days later). One dog received systemic cyclosporine and steroid medications and maintained vision in the contralateral eye; however, regular ERG rechecks showed a trend of declining amplitude (448 days). In this dog, optical coherence tomography (OCT) showed different stages of disorganized retinal layers as well as different retinal thickness between the eyes. Despite normal-looking fundi, ERG and OCT revealed different degrees of retinal changes between both eyes in this study. Eyes with vision might develop progressive blindness after a substantial amount of time in these presumed SARDS cases.

Intraocular Pressure Elevation Following the Use of Topical Dexamethasone Ointment After Squint Surgery.

Purpose:To describe the pattern of intraocular pressure (IOP) changes after squint surgery in eyes of black Africans at the University College Hospital, Ibadan, Nigeria.Materials and Methods:This was a retrospective review of the clinical records of patients who underwent squint surgery between 2010 and 2019. Data on demographic characteristics, preoperative and postoperative intraocular pressure values, co-existing ocular pathology, type of strabismus, surgery performed, frequency and duration of postoperative topical steroid use and treatment received for elevated intraocular pressure were collected and descriptively summarised.Results:Thirty-six (39.1%) out of 92 patients who had squint surgery during the study period met study inclusion criteria. Mean age was 20.5 ± 13.6 years. All patients were administered Maxitrol® ointment postoperatively. Baseline, peak and net change in IOP were 12.9 ± 2.6 mmHg, 21.3 ± 6.8 mmHg and 8.39 ± 7.2 mmHg respectively. Thirty-one (86.1%) patients had elevation in IOP from baseline; 21 (67.7%) of these had significant IOP elevation. Topical steroid therapy was tailed off rapidly for all patients with significant IOP elevation. Twelve patients were commenced on topical IOP lowering medications, with normalization of intraocular pressure in majority of them by three months after surgery.Conclusion:Elevated intraocular pressure with the use of topical dexamethasone ointment after squint surgery was common in this study and majority of the patients had significant elevation in intraocular pressure. Close monitoring of the intraocular pressure of black patients, especially children, on topical steroid medication after squint surgery is strongly recommended.

Objective measurement of adherence to topical steroid medication after penetrating keratoplasty using an electronic monitoring aid: A pilot study.

ObjectivesCorneal transplantation is the most common transplant worldwide and its success critically depends on the management of corneal graft rejection through topical steroid therapy during the first 12 months after surgery. There is currently no published data on adherence after keratoplasty. This pilot study aims to explore the adherence to topical steroid after penetrating keratoplasty using a smart electronic device.MethodsThirty patients undergoing penetrating keratoplasty were included to evaluate the adherence to topical dexamethasone medication for 12 months after surgery. Patients received the usual post-transplantation treatment (topical dexamethasone) and follow-up after surgery (day 15, months 1, 2, 3, 4, 5, 6, 9, and 12). Adherence to treatment was monitored using the KaliJAR device (Kali Care, Santa Clara, CA, USA), which recorded the number of single-dose units (SDU) discarded. At control visits, data recorded by the device were compared to the manually count of SDU. Adherence ratio and individual adherence curve were explored for all patients.ResultsData from 27 patients showed a high agreement between adherence ratio calculated based on the device data and obtained from manual counting of the discarded SDU (intraclass coefficient correlation of 0.87 [95% CI: 0.738–0.938]). Mean adherence to the treatment over the 12-month study period was 95.2 ± 4%.ConclusionsAdherence to topical dexamethasone for 12 months after corneal transplantation was high. The connected device was able to record accurately the discarded SDU. This approach would be a particular interest in the early identification and personalized follow-up of poorly adherent patients.

Deficiency of Interleukin-1 Receptor Antagonist: New Genetic Autoinflammatory Disease as a Diagnostic Challenge for Pediatricians.

Deficiency of interleukin-1 receptor antagonist is a rare autoinflammatory disease that affects infants early in life. It often presents with systemic inflammation, skin and bone involvement. We present a 5-month-old boy who was hospitalized due to generalized erythematous pustular eruption with secondary impetigo, cellulitis, bronchiolitis, and elevated inflammatory markers. The patient was unresponsive to multiple courses of intravenous antibiotics, systemic, and topical steroid medications. The patient was evaluated by dermatology and rheumatology services among other subspecialities. Skin biopsy showed changes consistent with psoriasiform dermatitis, while bone scans showed multifocal osteomyelitis. The patient was started empirically on anakinra with improvement at 72 hours upon administration. This is one of the youngest reported case in the literature to be started on anakinra empirically prior to genetic confirmation of the mutation. A comprehensive literature review revealed that approximately 20 genetically confirmed patients, including our patient, have been reported with this genetic disease. It is imperative to recognize this disease early to achieve adequate response and remission. Therefore, clinical symptoms and the associated differential diagnosis for this disease should be constantly reassessed and reviewed by pediatricians and subspecialists to detect the disease as early as possible and reduce the high morbidity and mortality associated with delayed diagnosis and treatment.

Therapeutic Strategies for Corneal Wound Angiogenesis

Corneal diseases are a major cause of blindness worldwide, resulting from corneal scarring and neovascularization. There is an unmet need for developing effective therapies to prevent and/or treat corneal neovascularization. Topical steroid medication, cautery, argon and yellow dye laser, and fine needle diathermy have all been advocated with varying degrees of success. Vascular endothelial growth factor family of proteins play a pivotal role in corneal neovascularization, and current therapies are aimed at disrupting the various steps in this pathway. Advancement in cell-based therapies and regulatory molecules as a therapeutic target for treating corneal neovascularization is gaining popularity. This review focuses on the current treatment modalities, new alternative therapies, potential new targets, and insights into the future research for this debilitating condition.

Panuveitis Associated With Granuloma Annulare in a Child

A 5-year-old child developed panuveitis with choroidal lesions. Topical steroid medications were insufficient to control the inflammation long-term. Granuloma annulare was subsequently diagnosed in association with the uveitis. Systemic immunosuppression with methotrexate was eventually required to control the skin lesions and uveitis. Uveitis associated with granuloma annulare may present with choroidal lesions and panuveitis in children.

Incidence and Clinical Characteristics of Enterococcus Keratitis

To study the incidence, clinically relevant factors, and antibiotic sensitivity profile of cases of enterococcal keratitis presenting at the New York Eye and Ear Infirmary between January 1, 1996, and December 31, 2005. The records of all corneal cultures submitted to the Microbiology Laboratory of the New York Eye and Ear Infirmary between January 1, 1996, and December 31, 2005, were reviewed. All cases that were positive for Enterococcus species were identified, and the corresponding patients' medical records were obtained and studied. There were 15 cases of enterococcal keratitis identified during the study period, and all were E. faecalis species. The age of the patients ranged from 17 to 98 years (mean age, 57.5 years). Twelve of the patients were women. Two patients developed keratitis in existing corneal grafts. Two patients were on topical steroid medications, with 1 having an existing corneal graft. Fourteen of the 15 had abnormalities of the ocular surface or wore contact lenses. Eight (53%) of the patients were soft contact lens wearers. Only 1 case was directly attributable to trauma. Fourteen (93%) of the bacterial isolates were sensitive to vancomycin. One case had intermediate sensitivity. Eleven cases resolved with topical antibiotics, 3 cases required penetrating keratoplasty, and in 1 case, the outcome is unknown. Enterococcus faecalis keratitis is associated with abnormalities of the corneal surface and contact lens wear. Most of the isolates were sensitive to vancomycin, although 1 was of intermediate sensitivity, the importance of which is not known.

Corneal Transplant Rejection Rate and Severity After Endothelial Keratoplasty

To examine the corneal transplant rejection rate and the rate of graft failure subsequent to rejection in the first 2 years after endothelial keratoplasty (EK) and to compare this to background data for similar cases of penetrating keratoplasty (PK). Anonymized data from consecutive cases of EK [deep lamellar (DLEK) or Descemet stripping (DSEK)] for Fuchs corneal endothelial dystrophy or pseudophakic bullous keratopathy operated on before August 2004 were collected in 4 participating centers. The number and timing of rejection episodes and cases of subsequent graft failure were recorded, together with the time to cessation of topical steroid medication. Two-year postoperative findings were compared with background data for similar patients undergoing PK recorded in the Swedish Corneal Transplant Registry. Rejection episodes were less frequent after EK than PK (P = 0.035). Fifteen (7.5%) of 199 EK cases had a rejection episode in the first 2 years after surgery versus 92 (13%) of 708 PK cases. Graft failure after rejection in EK may have been less frequent than in PK (P = 0.063), with only 1 (6.7%) case of rejection after EK versus 26 (28.3%) cases of rejection after PK proceeding to graft failure. A strong trend toward continued use of low-dose topical steroid medication was observed in the EK group. Eighty percent of EK patients were still taking topical steroid medication 2 years after surgery, whereas topical steroid medication had been ceased within a year of surgery in almost all PK patients in the comparator group. Corneal transplant rejection is less frequent and may be less severe after EK than after PK. It is not yet clear whether these apparent differences are simply a product of relatively prolonged postoperative topical steroid cover in EK patients.

The potential role of specific essential oils in the replacement of dermacorticoid drugs (strong, medium and weak) in the treatment of acute dry or weeping dermatitis

The appearance of acute dermatitis, whether it is mediated by the immune system (contact eczema, atopic dermatitis, psoriasis) or not (ortho-ergic/contact irritant dermatitis) often requires in the first instance, the use of topical treatments based on topical steroid medications. The effectiveness of these substances for crisis intervention is not disputed. However, the secondary effects that accompany these medications often lead the practitioner to search for alternatives to their use. This article reports on a number (45) of acute dry and weeping dermatitis cases that were treated with specific formulations of essential oils over a nine month period. Rationale for both the essential oil selections and the galenic forms used are included along with results of treatment.

Utilization of topical steroids and topical immunomodulators in the United States

Atopic dermatitis (AD) is a common disease of the skin with worldwide prevalence, affecting over 20% of the population. Socioeconomic studies indicate that an estimated 0.9 to 3.8 billion dollars are spent in the United States annually, ranking this disease as the 6th most expensive to treat. Topical steroids have been the mainstay of therapy in AD. Concerns regarding usage of topical steroid medications include skin atrophy, telangiectasia, and steroid-induced rosacea. In January 2001, the first topical immunomodulator (TIM), tacrolimus ointment, was approved for the treatment of moderate to severe AD. Subsequently, pimecrolimus cream was introduced in January 2002 for the treatment of mild eczema. To determine the significance of these new agents, data from National Data Corporation, an independent data collection company that gathers information on prescribing trends from participating pharmacies, were analyzed quarterly from January 2001 to 2003. The numbers of prescriptions written for TIMs and topical steroids by dermatologists and primary care physicians (pediatricians, family practitioners, and internists) were evaluated. The number of prescriptions for topical steroids did not show any appreciable changes, averaging about 4.5 million prescriptions/quarter. In contrast, utilization of TIMs has been steadily increasing. About 950K prescriptions are written for TIMs per quarter with topical steroids to TIMs prescription ratio of 5:1. Utilization of TIMs by dermatologists began immediately after product release and has continued to increase, with a prescription ratio of topical steroids to TIMs of 3:1. In contrast, utilization of TIMs by primary care physicians lagged. Currently, the number of prescriptions written for TIMs and the ratio of steroids to TIMs prescribed is comparable between dermatologists and pediatricians. Use of TIMs by family physicians and internists are increasing but still lags when compared to dermatologists, with a steroid to TIMs prescription ratio of about 8:1. These data suggest that TIMs are increasingly used in the routine treatment of eczema and prescribed in combination with topical steroids.

Corneal epithelial cell migration in humans: ‘Hurricane and blizzard keratopathy’

Replicative turnover of the corneal epithelium is believed to occur from a population of stem cells located at the corneo-scleral limbus. During the healing of corneal epithelial wounds, sheets of epithelial cells move centripetally from the limbus and circumferentially along the limbus to cover the defect. A whorled or vortex pattern, similar to that seen in cornea verticillata, has been reported to occur on the corneal surface as an effect of topical steroid medication, during the healing of grafted corneas. This condition has been termed 'hurricane keratopathy'. We have noted this appearance in 6 patients who did not have corneal grafts. In all our patients the whorled pattern was best visible on fluorescein staining. This feature differentiates 'hurricane keratopathy' from cornea verticillata secondary to deposition of substances in corneal epithelial cells. Further, in all our patients the vortex was clockwise. Examination of illustrations of 'hurricane keratopathy' and cornea verticillata reported in the literature reveals that the whorled pattern is almost always clockwise. We believe that this specific pattern is likely to be due to the effect of the electromagnetic fields of the eye on the migrating epithelial cells and present a theory to explain this phenomenon. In 3 eyes of 2 other patients with chronic epitheliopathies we observed a random distribution of cells that did not conform to any specific pattern. We have termed this condition 'blizzard keratopathy'.

Cushingoid Status: Induced by Topical Steroid Medication

Cushingoid Status: Induced by Topical Steroid Medication