You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Comparison of Efficacy and Ocular Surface Toxicity of Topical Preservative-free Methylprednisolone and Preserved Prednisolone in the Treatment of Acute Anterior Uveitis

Hedayatfar, Alireza MD*,†; Hashemi, Hassan MD*,‡; Asgari, Soheila MSc*; Chee, Soon-Phaik FRCS(G), FRCOphth§,¶,‖,**

Cornea:
doi: 10.1097/ICO.0000000000000039
Clinical Science
Abstract

Purpose: The aim of this study was to compare the antiinflammatory effect and ocular surface toxicity of topical nonpreserved methylprednisolone sodium succinate 1% and preserved prednisolone acetate suspension 1% for the management of acute anterior uveitis (AAU).

Methods: In this prospective, randomized, investigator-masked, comparative clinical trial, patients with mild-to-moderate noninfectious AAU were assigned randomly to receive either hourly nonpreserved methylprednisolone 1% (group A) or preserved prednisolone 1% (group B) eye drops followed by a 2-week tapering regimen. Anterior chamber cells and flare were clinically evaluated for the objective comparison of the antiinflammatory effect. The main outcome measure was the percentage of patients with a resolution of inflammation (anterior chamber cells <1+) on day 14. Ocular surface toxicity was assessed by means of the corneal fluorescein staining score, tear breakup time, Schirmer I test, and questionnaire-based grading of ocular discomfort parameters.

Results: Seventy-two eyes of 68 patients were studied, of which 38 eyes were enrolled in group A and 34 eyes were enrolled in group B. On day 14, 76.3% of the patients in group A had resolution of inflammation compared with 70.6% of the patients in group B, proving noninferiority (χ2 = 0.303, P = 0.582). The mean anterior chamber cell grade reduction for patients in group A was similar to that in group B (2.52 vs. 2.86, respectively; P = 0.92). Group A patients showed significantly lower corneal fluorescein staining scores (P < 0.001) and reported milder subjective ocular discomfort (0.55 vs. 1.43, P = 0.01) as compared with group B.

Conclusions: Both preparations demonstrated equal antiinflammatory effects for the treatment of AAU. Nonpreserved methylprednisolone eye drops exhibited a significantly lower ocular surface toxicity profile and milder subjective discomfort when compared with that exhibited by preserved prednisolone.

Author Information

*Noor Ophthalmic Research Center, Noor Eye Hospital, Tehran, Iran;

Ophthalmology Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran;

Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran;

§Ocular Inflammation & Immunology Service, Singapore National Eye Centre, Singapore;

National University of Singapore, Singapore;

Singapore Eye Research Institute, Singapore;

**Duke-National University of Singapore Post Graduate Medical School, Singapore.

Reprints: Alireza Hedayatfar, Ocular Inflammation and Uveitis Clinic, Noor Eye Hospital, 96 Esfandiar Boulevard, Vali'asr Avenue, Tehran 196865311, Iran (e-mail: ahedayatfar@norc.ac.ir).

The authors have no funding or conflicts of interest to disclose.

Received August 30, 2013

Accepted October 22, 2013

© 2014 by Lippincott Williams & Wilkins.