Attenuation of Ocular Hypertension With the Use of Topical Loteprednol Etabonate 0.5% in Steroid Responders After Corneal Transplantation

Purpose: To describe a clinically observed reduction in intraocular pressure (IOP) without increased allograft rejection in known steroid responders using loteprednol etabonate 0.5% ophthalmic suspension as second-line rescue therapy after corneal transplantation. Methods: Medical records from a prespecified 15-month period were retrospectively reviewed for all post-corneal transplant patients in whom loteprednol etabonate was initiated and prednisolone acetate 1.0% ophthalmic suspension withdrawn because of a secondary increase in IOP. Elevated postoperative IOP was defined as IOP that increased >= 21 mm Hg. Baseline IOP values were compared with IOP readings at follow-up examinations, with data points set retrospectively at 0-4, 4-8, 8-16, 16-32, and >32 weeks. Patient records were evaluated for any signs of allograft rejection during loteprednol etabonate therapy. Results: Thirty patients were found to have switched to loteprednol etabonate after an increase in IOP during postoperative prednisolone acetate treatment. The mean reduction in IOP observed when comparing initial and final values in all 30 patients was 12.9 mm Hg during a mean follow-up of 21.6 weeks. The mean percent reduction in IOP during loteprednol etabonate treatment was 32.6% at 3 weeks and 44.9% at 39 weeks. No clinically observed signs of allograft rejection were documented. Conclusions: Switching to loteprednol etabonate from prednisolone acetate in known steroid responders was successful in reducing IOP and did not increase the risk of allograft rejection. Because of its lower potential for causing elevated IOP, loteprednol etabonate should be considered in the prophylaxis of allograft rejection in steroid responders.