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Difluprednate increases IOP in cases of persistent hypotony

Issue: November 25, 2018

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Tarek S. Hassan

CHICAGO — Topical difluprednate did increase IOP when used as monotherapy in eyes with persistent hypotony after treatment for proliferative vitreoretinopathy, a speaker here said.

“Large retinectomies that we make during PVR repair can expose more [retinal pigment epithelium], more choroid, more sclera, which gives you increased aqueous outflow. More uveal scleral outflow causes post PVR repair hypotony,” Tarek S. Hassan, MD, said at Retina Subspecialty Day preceding the American Academy of Ophthalmology annual meeting. “Attempts recently to treat post-PVR repair hypotony have been largely unsustainable and temporary.”

Hassan reported on a retrospective series of 11 eyes with hypotony previously treated with 1% prednisolone acetate after PVR repair that were then treated four times daily with difluprednate alone, using its side effect of increased IOP as the intended mechanism of action. Studies have shown difluprednate significantly increases IOP after vitrectomy compared with prednisolone, he said.

All patients had IOP of less than 5 mm Hg for at least 3 months after their last successful retina surgery and were followed for at least 3 months after initiation of treatment. Types of retina surgery varied but all patients had retinectomies of at least 4 clock hours.

Mean time from last surgery to difluprednate intervention was 28 months, with mean follow-up of 13.5 months.

“We did not expect to see a significant visual change, and indeed we did not, but intraocular pressure did,” Hassan said.

Mean pretreatment IOP was 4 mm Hg, whereas mean final IOP was 11 mm Hg. IOP increased in 10 of 11 eyes, and the increase was more than 4 mm Hg in 9 of 11 eyes.

“Difluprednate given four times daily does increase the IOP in some eyes with end stage persistent hypotony after successful PVR repair. These eyes have not been responsive to steroid treatment given in another method,” Hassan said. – by Patricia Nale, ELS

Reference: Hassan TS. Treatment of persistent hypotony in eyes with successfully treated proliferative vitreoretinopathy. Presented at: AAO Subspecialty Day; Oct. 26-27, 2018; Chicago.

Disclosure: Hassan reports he is a consultant for Alcon.