Summary
Recent developments in pharmaceuticals and technology now give us more choices for treating intraocular inflammation. Newer developments in eyedrops now give us different "strengths" of steroid eyedrops. New drug delivery systems will be giving us sustained release of steroids.
Analysis
Steroid eye drops have been the mainstay of anti-inflammatory treatment for decades indicated for most types of ocular surgery and inflammatory conditions of the eye. The gold-standard of anti-inflammatory eyedrops has been prednisolone acetate 1% (Pred Forte, OmniPred). Prednisolone acetate 1% has been effective in controlling intraocular inflammation as well as inflammation of the palpebral and bulbar conjunctiva. In most cases, the medicine is extremely effective. A commonly known side effect of prednisolone acetate 1% is the rise in IOP (intraocular pressure) seen in as much as 10% of the population.
Durezol (difluprednate) was recently released as a topical synthetic steroid indicated for post-surgical inflammation. The drug reportedly has no rise in intraocular pressure, yet has the same anti-inflammatory "power" as prednisolone acetate 1%. Dosing is also decreased starting as 4x per day and then quickly tapered to 2x per day.
Vexol (timexolone) is known as a "soft" steroid. It has less anti-inflammatory properties and is indicated for treatment of inflammatory conditions of the anterior segment and surgery. IOP rise is possible.
Lotemax (loteprednol etabonate) is also a "soft" steroid, has decreased anti-inflammatory properties, does have IOP spikes and is indicated for inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment.
LASIK surgery is commonly treated with prednisolone acetate 1% 4x/day for about one week. There is generally limited corneal and anterior segment inflammation.
Intravitreal injections of triamcinolone acetonide (Kenalog) has been popular over the past several years. In this modality, the steroid is injected directly into the vitreous. Intraocular pressure rise possible. Triesence (triamcinalone) is preservative-free is injectable and has reduced IOP rise.
Most intriguing is last week's FDA approval of Ozurdex, a biodegradable sustained release drug delivery system. Ozurdex is injected into the vitreous cavity and releases dexamethasone for a limited time. It is indicated for the treatment of macular edema caused by vein occlusions. The off-label use for intraocular inflammation is sure to follow for treatment of refractory uveitis and possible post-operative inflammation of the anterior segment and posterior segment (retina).
Randall V. Wong, M.D.
Analyses are solely the work of the authors and have not been edited or endorsed by GLG.
