First Author: M.Dogan TURKEY
Co Author(s): A. Bilgin Y. Ayaz C. Apaydin
Back to previous
To compare the efficacy and safety of postoperative topical loteprednol etabonate 0,5% (LE) with dexamethasone 0,1% (DEX) for the treatment of inflammation after pars plana vitrectomy (PPV).
The present study is a prospective, randomized, double-blind, single centre study. One-hundred-fifty eyes of 150 patients who underwent transconjunctival PPV for in various diagnoses with 25-G or 23-G systems between November 2013 and June 2014 were registered. Surgeries were performed at Akdeniz University School of Medicine.
One-hundred-fifty eyes of 150 patients who underwent transconjunctival pars plana vitrectomy for various diagnoses were registered in this prospective, randomized study. The patients were assigned into two groups: Group LE (n = 75) received loteprednol etabonate and Group DEX (n = 75) received dexamethasone. Subjects self-administered the drops in both of the groups, beginning every hour for the first day, every two hours for two days, six times a day for the rest of the week, four times a day for week two, two times a day for week three and once a day for week four. All the patients received prophylactic antibiotics for two weeks. In the postoperative follow up, if the patients IOP were above 25 mmHg, anti-glaucoma medications were given. The follow up time was at least three-months in all patients. Patients were seen 4 times after they were determined to be eligible: preoperatively and at days 1, 3 and 30 postoperatively. Intraocular inflammation, intraocular pressure (IOP) and the intensity of postoperative pain were compared between the groups.
There were no statistically significant differences in age or sex between the groups. No postoperative complications were recorded in either group. Mean IOP was higher in patients treated with DEX than with LE but there was no statistically significant difference between the groups in postoperative mean IOP (p > 0.05). The anti-glaucoma medications were considered for four eyes (5,3%) in Group LE and 13 eyes (17,3%) in Group DEX, which was a statistically significant difference (p = 0.020). At postoperative days one and three, there was a statistically significant difference in Tyndall scores in favor of the Group DEX (respectively, p=0.01, p=0.017). There was no residual postoperative inflammation on day 30 in either group. When considering the postoperative pain, on day one, the patients were more likely to have mild or moderate pain in Group LE (p<0.001). On day three, patients with no pain was higher in Group DEX (p=0.005). The pain perception was less in the subjects in Group DEX when compared to Group LE on first and third postoperative days. At the end of the one month, none of the patients had ocular pain and the signs of intraocular inflammation were almost undetectable in either group.
Although there have been big advancements in vitreoretinal surgical procedures, postsurgical ocular inflammation and pain continue to create difficulties. Topical corticosteroids are routinely used as postoperative ocular anti-inflammatory drugs; however, adverse effects such as increased intraocular pressure (IOP) are observed with their use. While older corticosteroids such as DEX and prednisolone acetate (PA) offer good anti-inflammatory efficacy, clinically significant increases in IOP are often associated with their use. Loteprednol etabonate, a novel C-20 ester-based corticosteroid, was retrometabolically designed to offer potent anti-inflammatory efficacy with decreased impact on IOP. To the best of our knowledge, there are no published data about the comparison with conventional corticosteroids to loteprednol in the treatment of postoperative inflammation following vitreoretinal surgery. In conclusion, although in the early postoperative days, topical DEX was more effective in controlling postoperative inflammation and pain, eventually topical LE appears to be as effective as topical DEX at the end of one month after pars plana vitrectomy. However, LE showed less increase in IOP in these patients and less need for anti-glaucoma medications. This study showed that topical loteprednol can be used safely for control of postoperative inflammatory response with minimal effect on IOP after PPV surgery.