Comparison of Post-operative Pachymetry After Penetrating Keratoplasty Using Prednisolone Acetate 1% Versus Loteprednol Etabonate 0.5%

1
Comparison of Post-operative Pachymetry After
Penetrating Keratoplasty Using Prednisolone
Acetate 1 Versus Loteprednol Etabonate 0.5

• E. Lillian Cheng, M.D.1, Catherine Furey, M.D.1,
  Robert Kaplan, Ph.D.2, and Theodore M. Perl,
  M.D.1
• 1Corneal Associates of New Jersey, West Orange,
  NJ and 2UCLA School of Public Health, Los
  Angeles, CA

2
Financial Interests

• This study was conducted by Drs. Perl, Furey and
  Cheng at Corneal Associates of New Jersey and was
  supported in part by Bausch Lomb
  Pharmaceuticals, Inc.
• Dr. Kaplan does not have any financial interests
  in the techniques or technologies discussed
  herein.

3
Introduction

• Endothelial viability is critical to ensure
  health and longevity of donors after penetrating
  keratoplasty.
• Central Corneal Thickness (CCT) is an indirect
  measure of endothelial function.
• Ultrasonic pachymetry is a well recognized tool
  for accurately measuring corneal thickness.
• Postoperatively, it takes a variable amount of
  time for the endothelial cells in the graft to
  reestablish function, and deturgesce the graft.
• Postoperative inflammation can prolong the
  recovery of endothelial function.
• Topical corticosteroids have been the mainstay of
  treatment of post op inflammation.

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Introduction

• Prednisolone acetate (1) (PA) is the gold
  standard for treatment of postoperative
  inflamamation after PKP. but has been associated
  with steroid induced IOP elevation.
• Loteprednol etabonate (0.5) (LE) is known to
  have a lesser effect on intraocular pressure
  rise, and has been shown to be as effective as PA
  in reduction of intraocular inflammation,
  post-cataract extraction.
• The purpose of this study was to compare the
  anti-inflammatory effects of LE versus PA on
  post-operative deturgesence, and recovery of
  endothelial function in the graft.

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Study Design

• We studied 115 eyes that underwent PKP or
  combined PKP/cataract extraction/intraocular lens
  implantation in one subspecialty practice.
• All surgeries were performed by one surgeon (TP)
  using the same technique, described previously.
  Patients were randomly assigned to use either PA
  (n72) or LE (n43) postoperatively.
• All patients were placed on either PA or LE every
  two hours for the first week post-op, and then
  tapered.
• CCTs were measured at each postoperative visit.

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Patient Demographics
Loteprednol Prednisolone
No. Eyes 43 72
Age (range) 56.52 (16-96) 59.06 (11-93)
Female 58.1 51.4
POAG 2.3 (1/43) 4.2 (3/72)
Donor Age (range) 42.0 (13-68) 44.9 (5-67)
Avg thinnest CT 540.7 535.5
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Study Design

• Patient charts were reviewed retrospectively to
  determine the point at which the thinnest CCT was
  achieved.
• Differences in outcomes between LE and PA
  patients were evaluated using independent groups
  t-tests.
• Sub-analyses were also done for
• Phakic keratoconus (KCN) patients
• Pseudophakic or aphakic bullous keratopathy
  (PBK/ABK) patients
• Patients who underwent triple procedures for
  Fuchs corneal dystrophy (FCD) and cataracts.

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Results
Loteprednol Prednisolone
ALL patients 14.6 (n43) 10.2 (n72)
KCN - phakic 13.0 (n17) 10.3 (n23)
FCD - triple 20.3 (n10) 11.8 (n12)
PBK/ABK 13.6 (n8) 9.4 (n19)
Average time in weeks to thinnest central graft
thickness
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Results

• The thinnest reading was reached significantly
  earlier for the PA patients (10.2 weeks) than for
  the LE patients, (14.6 weeks) (p lt 0.001).
• This effect was similar for PBK/ABK patients,
  (13.6 weeks vs. 9.4 weeks)(p 0.01), and even
  more distinct for FCD/cataract patients (20.3
  weeks vs. 11.8 weeks) (p 0.02).
• Differences between treatment groups were not
  significant for the KCN only (phakic) patients, (
  13.0 weeks vs. 10.3 weeks) (p 0.20).
• Although there were more patients on PA,
  variances between groups were homogeneous.
• Differences between groups for thickness were
  non-significant.

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Complications

• 11 patients (15.3) in the PA group developed
  steroid-induced glaucoma, whereas none (0.0) of
  the LE patients had significantly raised
  intraocular pressure.
• Graft rejection within one year of surgery
  developed in 3 (4.2) of the PA patients versus 2
  (4.7) of the LE patients.

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Conclusion

• PA is more effective than LE regarding post op
  graft deturgescence, and is associated with
  reaching the thinnest CCT earlier.
• The rate of rejection episodes within one year is
  similar between the two groups.
• There is a significantly greater risk of
  developing steroid-induced glaucoma with PA than
  with LE.

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References

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• Novack GD, et al. Change in intraocular pressure
  during long-term use of loteprednol etabonate. J
  Glaucoma. 1998 7(4)266-9.
• Grigorian RA, et al. Comparison of loteprednol
  etabonate 0.5 (Lotemax) to prednisolone acetate
  1 (Falcon) for inflammation treatment following
  cataract surgery. Poster presentation.
• Randleman JB and Stulting RD. Prevention and
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