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A retrospective analysis of intraocular pressure changes after cataract surgery with the use of prednisolone acetate 1% versus difluprednate 0.05%

Authors Kusne Y, Kang P, Fintelmann RE

Received 8 September 2016

Accepted for publication 25 October 2016

Published 23 November 2016 Volume 2016:10 Pages 2329—2336

DOI https://doi.org/10.2147/OPTH.S121849

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Yael Kusne,1 Paul Kang,1 Robert E Fintelmann1,2

1University of Arizona College of Medicine–Phoenix, 2Barnet Dulaney Perkins Eye Center, Phoenix, AZ, USA

Purpose:
To compare the effect of topical prednisolone acetate 1% (PA) used after routine cataract surgery to the effect of difluprednate 0.05% (DFBA) used for the same indication on intraocular pressure (IOP).
Methods: An electronic query was created to gather information from all cataract surgeries between January 2010 and January 2015 within the electronic health record database at Barnet Dulaney Perkins, a multicenter, multiphysician private practice in Phoenix, Arizona. Information collected included age, sex, diabetes status, glaucoma history, medication regimen (use of PA or DFBA), and IOP before surgery, 5–10 days postoperatively (TP1) and 3–6 weeks postoperatively (TP2). Postoperative IOP measurements were compared to baseline IOP measurement in each patient.
Results: Regardless of steroid used, all patients in this study experienced an increase in IOP within TP1 and returned to baseline IOP (±2.0 mmHg) by TP2. Patients who received DFBA showed a statistically significant increase in IOP at TP1 compared to those on PA (P<0.001) with the mean IOP an average 0.60 mmHg higher (95% CI =0.3, 0.9). The odds ratio of a clinically significantly increased IOP at TP1 (defined as overall IOP ≥21 mmHg and an increase of ≥10 mmHg) in DFBA-treated patients was 1.84 (95% CI =1.4, 2.6). In patients treated with PA, 3% reached a significantly increased IOP, compared to 4.4% of patients in the DFBA group (P<0.05). Risk factors for increased IOP were identified, and include advanced age (>75) (P<0.005) and a history of glaucoma (P<0.001).
Conclusion: In postoperative cataract patients, use of DFBA increased the risk of a clinically significant IOP increase.

Keywords: intraocular pressure, cataract surgery, steroid responder, glaucoma

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