Uveitic CME is a common indication for systemic immunosuppression or intravitreal steroid therapy. Unfortunately, these treatments are not without potential risks. This study suggests that topical diflupredante may have a role in the treatment of uveitic CME. Although topical difluprednate is not free from the potential to induce cataract and glaucoma, many pseudophakic patients may be able to tolerate it long term, and it may be a much less risky treatment strategy in responsive patients. it suggests that topical difluprednate may have sufficient potency to treat uveitic macular edema. This finding warrants further study, as does the possibility of a potential synergistic effect with topical nonsteroidal antiinflammatory drug.

Cystoid macular edema (CME) is a common complication of posterior segment inflammatory eye disease and can be a cause of significant visual morbidity. Treatment strategies, including systemic immunosuppression and intravitreal/periocular steroid therapy, may be associated with systemic or local side adverse effects. In some cases, uveitic CME may respond partially to topical agents, including corticosteroids. The effect of topical corticosteroids in this regard is limited by their ability to reach therapeutic concentrations at the macula.

Difluprednate 0.05% ophthalmic is a new topical corticosteroid with greater potency than and superior tissue penetration to other topical ophthalmic preparations. In the treatment of acute anterior uveitis, difluprednate appears to have twice the potency of topical prednisolone acetate 1%.6,7 In recent studies, difluprednate was shown to reduce macular thickening in diabetic macular edema, after cataract surgery, and in uveitic CME in pediatric patients. It has also been successfully used as monotherapy to treat Vogt–Koyanagi–Harada (VKH) syndrome–associated serous retinal detachments.

In recent studies, difluprednate was shown to reduce macular thickening in diabetic macular edema, after cataract surgery, and in uveitic CME in pediatric patients. It has also been successfully used as monotherapy to treat Vogt–Koyanagi–Harada (VKH) syndrome–associated serous retinal detachments.

This Retrospective review of uveitic macular edema where the patients were treated with topical difluprednate monotherapy. Results yield complete resolution of uveitic macular edema within2–4 weeks. We observed a statistically significant improvement in central subfield macular thickness(p ¼ 0.04). In clinical practice, a trial of topical difluprednate for uveitic CME may be considered before the patient

is subjected to more aggressive treatment. The increased potency and superior tissue penetration of

difluprednate would make it a better choice in this regard than other topical steroid preparations. Such a

trial of therapy could occur while investigations are completed in the planning/preparation of the patient

for more risky treatment such as immunosuppression. Future prospective and randomized studies will

better define the role of topical difluprednate in the treatment paradigm for uveitic CME.

Source : CAN JOPHTHALMOL—VOL. 51,NO.1,FEBRUARY2016, 47-49.

Source : CAN J OPHTHALMOL—VOL. 51, NO. 1, FEBRUARY 2016, 47-49.