ABSTRACT
PURPOSE: To describe a clinically observed reduction in intraocular pressure (IOP) without increased allograft rejection in known "steroid responders" using loteprednol etabonate 0.5% ophthalmic suspension as second-line rescue therapy after corneal transplantation. METHODS: Medical records from a prespecified 15-month period were retrospectively reviewed for all post-corneal transplant patients in whom loteprednol etabonate was initiated and prednisolone acetate 1.0% ophthalmic suspension withdrawn because of a secondary increase in IOP. Elevated postoperative IOP was defined as IOP that increased > or =21 mm Hg. Baseline IOP values were compared with IOP readings at follow-up examinations, with data points set retrospectively at 0-4, 4-8, 8-16, 16-32, and >32 weeks. Patient records were evaluated for any signs of allograft rejection during loteprednol etabonate therapy. RESULTS: Thirty patients were found to have switched to loteprednol etabonate after an increase in IOP during postoperative prednisolone acetate treatment. The mean reduction in IOP observed when comparing initial and final values in all 30 patients was 12.9 mm Hg during a mean follow-up of 21.6 weeks. The mean percent reduction in IOP during loteprednol etabonate treatment was 32.6% at 3 weeks and 44.9% at 39 weeks. No clinically observed signs of allograft rejection were documented. CONCLUSIONS: Switching to loteprednol etabonate from prednisolone acetate in known steroid responders was successful in reducing IOP and did not increase the risk of allograft rejection. Because of its lower potential for causing elevated IOP, loteprednol etabonate should be considered in the prophylaxis of allograft rejection in steroid responders.
Subject(s)
Androstadienes/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Corneal Transplantation/adverse effects , Ocular Hypertension/drug therapy , Ocular Hypertension/etiology , Prednisolone/analogs & derivatives , Administration, Topical , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Drug Administration Schedule , Female , Graft Rejection/prevention & control , Humans , Intraocular Pressure/drug effects , Loteprednol Etabonate , Male , Middle Aged , Prednisolone/administration & dosage , Prednisolone/adverse effects , Retrospective Studies , Salvage Therapy , Young AdultABSTRACT
PURPOSE: To compare the preoperative and postoperative measurement of corneal biomechanical properties and intraocular pressure (IOP) using Goldmann applanation tonometry (GAT), the ocular response analyzer (ORA), and the Pascal dynamic contour tonometer (PDCT) in eyes undergoing myopic laser in situ keratomileusis (LASIK). DESIGN: Prospective, nonrandomized clinical trial. METHODS: IOP was measured in 66 myopic eyes before and after LASIK by GAT, ORA, and PDCT in a randomized sequence. Metrics of corneal biomechanical properties (corneal hysteresis [CH], corneal resistance factor [CRF], and ocular pulse amplitude [OPA]) were recorded. RESULTS: After LASIK, there was a reduction in mean corneal pachymetry of 90.2 mum and in IOP measurements with GAT (Delta = -1.8 +/- 2.8 mm Hg; P < .01), ORA-Goldmann (Delta = -4.6 +/- 2.8 mm Hg, P < .01), and ORA-corneal compensated (Delta - 2.1 +/- 2.6 mm Hg; P < .05). However, there was no statistically significant difference between preoperative and postoperative IOP measurements taken by PDCT (Delta = -0.5 +/- 2.6 mm Hg). Postoperatively, CRF decreased by 28.6% (P < .01), CH by 16.2% (P < .01), and OPA by 1.8% (P = .32). CONCLUSIONS: Measurement of IOP with PDCT appears to be relatively immune to changes in corneal biomechanics and pachymetry after LASIK, in comparison to GAT and ORA measures of IOP. PDCT and ORA both showed statistically lower variation in measurement than GAT. LASIK produced a marked decline in CH and CRF, which may reflect respective changes in the viscous and elastic qualities of the post-LASIK cornea. In contrast, there was no statistical change in OPA.
