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RESOLUTION OF NONINFECTIOUS UVEITIC CYSTOID MACULAR EDEMA WITH TOPICAL DIFLUPREDNATE

Feiler, Daniel L. MD; Srivastava, Sunil K. MD; Pichi, Francesco MD; Bena, James MS; Lowder, Careen Y. MD, PhD

doi: 10.1097/IAE.0000000000001243
Original Study
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Purpose: To evaluate the short-term safety and efficacy of topical difluprednate (0.05%) for the treatment of noninfectious uveitic cystoid macular edema.

Methods: Twenty-seven patients (35 eyes) undergoing treatment with difluprednate 4 times daily for 3 weeks for noninfectious uveitic cystoid macular edema were reviewed for visual acuity, intraocular pressure, optical coherence tomography, and fluorescein angiography results. A mixed model analysis was fit with each measure as the outcome, visit as the primary predictor, and patient and eye as random effects.

Results: Mean central foveal thickness decreased by 117 μm (P < 0.001) at 30 ± 15 days, 124 μm (P < 0.001) at 60 ± 15 days, and 152 μm (P < 0.001) at 180 ± 30 days. Complete resolution of intraretinal fluid was observed in 15 of 34 (44%) eyes at 30 ± 15 days, 11 of 21 (52%) eyes at 60 ± 15 days, and 9 of 12 (75%) eyes at 180 ± 30 days. Improvement in fluorescein leakage was noted in 7 of 8 eyes (88%). Visual acuity improved by a mean of 5 letters (P = 0.001) at 30 ± 15 days, 5.5 letters (P = 0.007) at 60 ± 15 days, and 7 letters (P = 0.032) at 180 ± 30 days. Mean increase in intraocular pressure was 1.48 mmHg at 30 ± 15 days (P = 0.080), 1.92 mmHg at 60 ± 15 days (P = 0.110), and 6.18 mmHg (P = 0.001) at 180 ± 30 days.

Conclusion: Topical difluprednate is a well-tolerated and effective treatment for noninfectious uveitic cystoid macular edema with decreased central foveal thickness, mild improvement in visual acuity, and elevation of intraocular pressure observed in a few patients.

This retrospective study demonstrates that difluprednate ophthalmic emulsion (0.05%) given four times daily for 3 weeks reduces central foveal thickness on optical coherence tomography in noninfectious uveitic cystoid macular edema with a mild increase in intraocular pressure.

Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.

Reprint requests: Careen Y. Lowder, MD, PhD, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH 44195; e-mail: lowderc@ccf.org

Presented at American Academy of Ophthalmology Annual Meeting, 2015.

S. K. Srivastava: Consultant—Bausch&Lomb, Santen, Optos, Zeiss, Leica, Allergan; Research: Allergan, Sanofi, Clearside, C. Y. Lowder: Consultant—Allergan. The remaining authors have no financial/conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.