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Corticosteroid reduces IOP, rejection risk after corneal transplantation
Cornea. 2009;28(10):1139-1143.
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Loteprednol etabonate reduced IOP and did not increase the risk of allograft rejection after corneal transplantation in at-risk patients, according to a study.
"Because of its lower potential for causing elevated IOP, loteprednol etabonate should be considered for prophylaxis of allograft rejection in steroid responders," the study authors said.
Investigators retrospectively reviewed 15 months of medical records from corneal transplantation patients who initiated loteprednol etabonate and discontinued prednisolone acetate 1% ophthalmic suspension because of a secondary rise in IOP, which was defined as an increase of 21 mm Hg or more.
Baseline IOP values were compared with follow-up readings recorded at 0 to 4 weeks, 4 to 8 weeks, 8 to 16 weeks, 16 to 32 weeks, and more than 32 weeks. Records were checked for signs of allograft rejection associated with use of loteprednol etabonate.
Study data showed that 30 patients initiated loteprednol after cessation of postoperative prednisolone because of elevated IOP. Records showed a mean reduction of IOP of 12.9 mm Hg during a mean follow-up interval of 21.6 weeks. Use of loteprednol etabonate was associated with a reduction in IOP of 32.6% at 3 weeks and 44.9% at 39 weeks. Records showed no clinical signs of allograft rejection, the authors reported.
Dr. Holland and colleagues present a nice retrospective study of post-transplant patients who have been switched from prednisolone acetate 1% to loteprednol etabonate 0.5% secondary to steroid-induced ocular hypertension. Balancing the anti-rejection benefits of topical steroids with their potential side effect of raising the eye pressure presents a tough challenge in post-graft patients in whom immunosuppression is particularly important. They demonstrated that patients may be effectively switched from prednisolone to loteprednol with improvement in IOP but without precipitating graft rejection. Further studies will need to examine if this remains true in complex cases, such as those post-graft patients with concomitant IOP rise and active inflammation or rejection.
– Edwin S. Chen, MD
Cornea Service, Wills
Eye Institute, Assistant Professor, Jefferson Medical College, Philadelphia