Article Date: 2/1/2005

Improve Surgical Outcomes
Thanks to fewer safety concerns, clinicians can prescribe loteprednol with confidence.

Most topical steroids effectively control postoperative corneal inflammation, but some eye doctors debate whether the benefits outweigh the risks associated with long-term use. Research suggests that loteprednol etabonate 0.5% (Lotemax) may be a safe alternative for controlling inflammation after corneal transplantation and refractive surgery. Here's what the panelists think.

Safety for steroid responders

Efficacy is only one criterion eye doctors consider when choosing postoperative steroids. They also must think about safety.

In one double-masked study, Jimmy D. Bartlett, O.D., F.A.A.O., compared how known steroid responders responded to loteprednol 0.5% or prednisolone 1.0% (Pred Forte). Previously, these patients had experienced at least a 10-mm IOP elevation while using prednisolone or dexamethasone.

"Every steroid has the potential to elevate IOP, but compared to prednisolone, patient response to loteprednol is muted and delayed," Dr. Bartlett says. "At 6 weeks, almost none of the patients using loteprednol experienced significant IOP elevation, and those who did had a lower net increase in IOP than the patients using prednisolone.

"Based on these results, loteprednol is effective enough to reduce inflammation and safe enough for chronic steroid therapy."

One patient population that definitely can benefit from the improved efficacy and safety of loteprednol is cornea transplant recipients.

Curbing rejection

Clinicians routinely prescribe steroids for cornea transplant patients to stabilize their tissue grafts. However, using ketone-based steroids for long-term therapy can elevate IOP, which is a documented factor in cornea rejection.

"Discontinuing steroids also increases the risk of graft rejection," says Paul M. Karpecki, O.D., F.A.A.O. "These patients really need an effective steroid that won't threaten the integrity of the transplant with continued use. Having something that doesn't increase IOP, like loteprednol, may be the ideal long-term medication for corneal transplant patients."

 

 
 

Every steroid has the potential to elevate IOP, but patient response to loteprednol is muted and delayed compared to prednisolone.

--Jimmy D. Bartlett, O.D., F.A.A.O.

Post-LASIK applications

Post-LASIK patients also are good candidates for long-term loteprednol therapy, especially those who are prone to diffuse lamellar keratitis (DLK).

Marc R. Bloomenstein, O.D., F.A.A.O., sees many post-LASIK patients who are still using topical steroids 2 or 3 weeks after surgery.

"We need to reconsider the conventional teaching that steroids slow the healing process, especially in refractive patients," he says. "One 6-week post-LASIK patient came to me with an abrasion on her cornea. As the abrasion healed, she developed an overlying DLK. To me, she was an ideal candidate for loteprednol therapy. She didn't need an antibiotic, but she could benefit from continuing steroid therapy for her DLK."

New possibilities

The benefits of using post-op loteprednol range beyond its anti-inflammatory capabilities. Because this agent is not a ketone-based steroid, it's less likely to elevate IOP with long-term use. As clinicians become more comfortable prescribing steroids, loteprednol's improved safety profile no doubt will help make it the steroid of choice.

 


Optometric Management, Issue: February 2005