• My Dashboard My Education Find an Ophthalmologist
  • Home
  • Coronavirus
  • For Ophthalmologists
    • Meetings
      • AAO 2022
        • Meeting Information
          • Past and Future Meetings
          • Mobile Meeting Guide
          • Contact Information
          • Annual Meeting News
          • Health and Safety
          • Policies and Disclaimers
        • Program
          • Program Highlights
          • Subspecialty Day
          • Virtual Meeting
          • Program Committees
          • CME
          • Meeting Archives
        • Expo
        • Registration
        • Hotels & Travel
          • Hotel Reservation Information
          • Chicago
          • International Attendees
          • Hotel Meeting Space
        • Presenter Central
          • Presenter Central
          • Abstract Selection Process
          • Submission Policies
          • Subject Classification/Topics
          • Instruction Courses and Skills Transfer Labs
          • Papers and Posters
          • Videos
          • Grand Rounds Symposium
          • Program Participant and Faculty Guidelines
          • Faculty Development Program
        • Exhibitors
          • Exhibitor Central
          • Exhibitor Portal Information
          • Exhibitor Prospectus
          • New Exhibiting Companies
          • Exhibitor Resources
          • International Exhibitors
          • Promotional Opportunities
          • Exhibitor Hotel Reservations
      • Mid-Year Forum
        • Registration and Travel
        • Congressional Advocacy Day
        • Advocacy Ambassador Program
        • Program
        • Schedule
        • Sponsored Attendees
        • News
      • Codequest
        • Codequest Instructors
        • Claim Codequest CME or CEU Credit
      • Eyecelerator
    • Clinical Education
      • COVID-19
      • Education
        • Browse All Education
        • Courses
        • Cases
        • Learning Plans
        • Interactive
        • Focal Points
        • Wills Eye Manual
        • Disease Reviews
        • Clinical Webinars
        • Diagnose This
        • Self-Assessments
        • Educational Centers
          • Glaucoma Education Center
          • Pediatric Ophthalmology Education Center
          • Laser Surgery Education Center
          • Myopia Resources
          • Oculofacial Plastic Surgery Center
          • Redmond Ethics Center
      • Journals
      • Guidelines
        • Browse All Practice Guidelines
        • Preferred Practice Patterns
        • Clinical Statements
        • Compendium Guidelines
        • Complementary Therapy Assessments
        • Medical Information Technology
        • Ophthalmic Technology Assessments
        • Patient Safety Statements
        • Choosing Wisely
        • Low Vision
        • Eye Care for Older Adults
        • Eye Disease Statistics
        • About the Hoskins Center
      • Video and Image Library
        • Browse All Videos
        • Clinical and Surgical Videos
        • Presentations and Lectures
        • 1-Minute Videos
        • Master Class Videos
        • Basic Skills Videos
        • Interviews
        • Images
        • Submit an Image
        • Submit a Video
      • Podcasts
        • Browse All Audio and Podcasts
        • Experts InSight
        • Ophthalmology Journal
      • News
        • Browse All Clinical News
        • Editors' Choice
        • Headlines
        • Current Insight
      • CME Central
        • Browse All CME Activities
        • Claim CME Credit and View Transcript
        • CME Planning Resources
        • Complete Your Financial Disclosure
        • Joint Sponsorship Portal
        • LEO Continuing Education Recognition Award
        • Safe ER/LA Opioid Prescribing
        • Check Your Industry Payment Records
      • MOC
      • Resident Education
        • Resident Education Home
        • Browse All Resident Content
          • Courses
          • Flashcards
          • Interactive Cases and Simulations
          • Videos
          • Webinars
        • OKAP and Board Exam Resources
          • OKAP Exam
          • Board Prep Resources
          • OKAP and Board Review Presentations
          • Study Flashcards
        • Cataract Master
        • Diversity and Inclusion Education
        • News and Advice from YO Info
        • Pediatric Ophthalmology Education Center
        • PGY-1 and PGY-2 Resources
        • Simulation in Resident Education
    • Membership
      • Join
      • Renew
      • Current Member
      • Volunteer
      • Physician Wellness
      • Member Directory
      • Member Obituaries
      • AAOE Membership
    • Advocacy
      • Advocacy News
      • Get Involved
        • Ways to Give
        • How to Get Involved
        • Congressional Advocacy
        • Support the Academy's Agenda
        • Research Legislation
        • Find Your Legislators
        • I Am an Advocate
        • Advocacy at Home
        • Advocate Tools
        • Best Practices for Advocating at Home
        • Social Media Toolkit
        • Letter to Editor
        • Town Hall Guide
        • Guide to Engaging With New Lawmakers
        • Resources
        • Attending a Political Fundraiser
      • OPHTHPAC
        • About Us
        • Join OPHTHPAC
        • OPHTHPAC Blog
      • Surgical Scope Fund
        • Support Surgery By Surgeons
        • Surgery By Surgeons Blog
    • Publications
      • EyeNet Magazine
        • Latest Issue
        • Archive
        • Subscribe
        • Advertise
        • Write For Us
        • Corporate Lunches
        • Contact
        • MIPS 2022
      • Focal Points
      • Ophthalmology
      • Ophthalmology Glaucoma
      • Ophthalmology Retina
      • YO Info
      • Scope
    • Subspecialties
      • Cataract/Anterior Segment
      • Comprehensive Ophthalmology
      • Cornea/External Disease
      • Glaucoma
      • Neuro-Ophthalmology/Orbit
      • Ocular Pathology/Oncology
      • Oculoplastics/Orbit
      • Pediatric Ophthalmology/Strabismus
      • Refractive Management/Intervention
      • Retina/Vitreous
      • Uveitis
    • IRIS Registry
      • About
      • Using the Registry
        • User Guide
        • Medicare Reporting
        • Maintenance of Certification
        • Non-EHR Reporting
      • Sign Up
        • Application Process
        • Why Participate
        • Once You've Applied: Getting Started
        • What Practices Are Saying About the Registry
      • Requirements
        • EHR Systems
        • Data & Technical Needs
      • Research
      • Registry Dashboard
      • News
      • Medicare & MIPS
    • Medicare Information
    • Diversity, Equity, and Inclusion
  • For Practice Management
    • Managing Your Practice
      • Managing Your Practice Topics
      • Coronavirus Resources
      • Reopening & Recovery
      • Practice Forms Library
      • Practice Management News and Advice
      • AAOE-Talk
      • Video Library
      • Ophthalmology Job Center
      • Benchmarking and Salary Tools
      • Academy Consultations
      • Consultant Directory
    • Coding
      • Coding Topics
      • Codequest Events
      • Ask the Coding Experts
      • Coding Updates and Resources
      • Coding for Injectable Drugs
      • EM Documentation
      • ICD-10-CM
      • Ophthalmic Coding Specialist (OCS) Exam
      • Retina
      • Savvy Coder
    • Webinars and Events
      • Annual Meeting
      • Codequest Courses
      • Mid-Year Forum
      • Webinar Recordings
    • IRIS Registry
      • Merit-Based Incentive Payment
    • Medicare and MIPS
      • MIPS
        • Quality
        • Promoting Interoperability
        • Improvement Activities
        • Cost
        • Avoid a Penalty
      • Resources
      • Medicare Participation Options
      • Medicare Advantage Plans
      • New Medicare Card
      • Provider Enrollment, Chain and Ownership System (PECOS)
    • Regulatory Compliance
      • HIPPA Resources
      • Office of Inspector General
      • Audits
      • OSHA
    • AAOE Membership
      • Join AAOE
      • Membership Benefits
      • Renew/Pay Dues
    • About AAOE
      • AAOE Board of Directors
      • AAOE Content Committee
      • Volunteer Opportunities
  • For Public & Patients
    • Eye Health A-Z
    • Symptoms
    • Glasses & Contacts
    • Tips & Prevention
    • News
    • Ask an Ophthalmologist
    • Patient Stories
    • No Cost Eye Exams
    • Español
      • A - Z de Salud Ocular
      • Síntomas
      • Anteojos y Lentes de Contacto
      • Consejos y Prevención
      • Noticias
      • Relatos de Pacientes
      • Exámenes de la vista sin costo
      • English
  • AAO 2022
    • Meeting Information
      • Past and Future Meetings
      • Mobile Meeting Guide
      • Contact Information
      • Annual Meeting News
      • Health and Safety
      • Policies and Disclaimers
    • Program
      • Program Highlights
      • Subspecialty Day
      • Virtual Meeting
      • Program Committees
      • CME
      • Meeting Archives
    • Expo
    • Registration
    • Hotels & Travel
      • Hotel Reservation Information
      • Chicago
      • International Attendees
      • Hotel Meeting Space
    • Presenter Central
      • Presenter Central
      • Abstract Selection Process
      • Submission Policies
      • Subject Classification/Topics
      • Instruction Courses and Skills Transfer Labs
      • Papers and Posters
      • Videos
      • Grand Rounds Symposium
      • Program Participant and Faculty Guidelines
      • Faculty Development Program
    • Exhibitors
      • Exhibitor Central
      • Exhibitor Portal Information
      • Exhibitor Prospectus
      • New Exhibiting Companies
      • Exhibitor Resources
      • International Exhibitors
      • Promotional Opportunities
      • Exhibitor Hotel Reservations
  • About
    • Who We Are
      • What We Do
      • About Ophthalmology
      • The Eye Care Team
      • Ethics and the Academy
      • History
      • Museum of Vision
      • Values
    • Governance
      • Council
      • Board of Trustees
      • Committees
      • Academy Past Presidents
      • Secretariats
      • Elections
      • Academy Blog
      • Academy Staff Leadership
    • Leadership Development
    • Awards
      • Laureate Recognition Award
      • Outstanding Advocate Award
      • Outstanding Humanitarian Service Award
      • International Blindness Prevention Award
      • Distinguished Service Award
      • Guests of Honor
      • Secretariat Award
      • Straatsma Award
      • Achievement Award Program
      • Artemis Award
      • EnergEYES Award
      • International Education Award
      • International Scholar Award
      • Commitment to Advocacy Award
      • Visionary Society Award
    • Financial Relationships
    • Policy Statements
    • Related Organizations
      • Subspecialty/Specialized Interest Society Directory
      • State Society Directory
      • Subspecialty/Specialized Interest Society Meetings
      • State Society Meetings
      • Resources for Societies
    • Year in Review
      • 2020 Year in Review
  • Foundation
    • About
      • 2020-2021 Annual Report
      • Annual Report Archives
      • News From the Chair
      • Foundation Staff
    • Our Impact
      • Partners for Sight
      • Donor Spotlights
      • Global Ophthalmic Community
      • Sponsorships
      • Patients and the Public
    • Giving Options
      • Our Supporters
      • Estate and Planned Giving
      • Ophthalmic Business Council
      • Parke Center Campaign
      • Minority Ophthalmology Mentoring Campaign
      • Museum of the Eye Campaign
    • Orbital Gala
      • Why Attend
      • Photo Recap
      • Corporate Support Opportunities
      • Tribute Gifts
      • Silent Auction
      • Corporate Sponsors
    • Donate
    • Museum of the Eye Campaign
      • Museum Supporters
  • Museum of the Eye
    • Visit
    • What's On
      • Museum Galleries
      • Special Exhibitions
      • Current Events
      • Past Events
    • Explore
      • Research and Resources
      • Collection Search
      • Previous Exhibits
      • Oral Histories
      • Biographies
    • Volunteer
    • Mailing List
    • Donate
    • About the Museum
      • Museum Blog
  • Young Ophthalmologists
    • YO Info
    • Learn to Bill
    • Engage with the Academy
  • Senior Ophthalmologists
    • Scope
    • Practice Transitions
  • International Ophthalmologists
    • Global Programs and Resources for National Societies
    • Awards
    • Global Outreach
  • Residents
  • Medical Students
×
Shop
Log In Create an Account
  • For Ophthalmologists
  • For Practice Management
  • For Public & Patients
  • Coronavirus
  • About
  • Foundation
  • Museum of the Eye
  • COVID-19
  • Journals
  • Education
    • Education
    • Courses
    • Cases
    • Learning Plans
    • Interactive
    • Focal Points
    • Wills Eye Manual
    • Disease Reviews
    • Clinical Webinars
    • Diagnose This
    • Self-Assessments
    • Education Centers
      • Glaucoma Education Center
      • Pediatric Ophthalmology Education Center
      • Laser Surgery Education Center
      • Oculofacial Plastic Surgery Center
      • Redmond Ethics Center
      • Myopia Resources
      • Thyroid Eye Disease Resources
  • Guidelines
    • Practice Guidelines
    • Preferred Practice Patterns
    • Clinical Statements
    • Ophthalmic Technology Assessments
    • Patient Safety Statements
    • Complementary Therapy Assessments
    • Compendium Guidelines
    • Medical Information Technology
    • Low Vision
    • Choosing Wisely
    • Eye Care for Older Adults
    • Eye Disease Statistics
    • About the Hoskins Center
    • Artificial Intelligence
    • Premium IOLs
    • Patient-Reported Outcomes with LASIK Symptoms and Satisfaction
  • Multimedia
    • Multimedia Library
    • Video
      • 1-Minute Videos
      • Presentations and Lectures
      • Master Class Videos
      • Basic Skills Videos
      • Clinical and Surgical Videos
      • Interviews
      • Resident Lectures
      • Submit a Video
      • YO Video Contest
    • Podcasts
      • Browse Podcast Archive
      • Experts InSight Podcast
      • Ophthalmology Journal Podcast
    • Images
      • Submit an Image
  • News
    • Clinical News
    • Editors' Choice
    • Headlines
    • Current Insight
  • CME
    • CME Central
    • Claim CME Credit and View Transcript
    • CME Planning Resources
    • Complete Your Financial Disclosure
    • Joint Sponsorship Portal
    • LEO Continuing Education Recognition Award
    • Safe ER/LA Opioid Prescribing
    • Check Your Industry Payment Records
  • MOC
  • Residents
    • Resident Education Home
    • Browse All Resident Content
      • Courses
      • Flashcards and Study Presentations
      • Interactive Cases and Simulations
      • Videos
      • Webinars
    • Cataract Master
    • Diversity and Inclusion Education
    • News and Advice from YO Info
    • OKAP and Board Exam Resources
      • OKAP Exam
      • Board Prep Resources
      • OKAP and Board Review Presentations
      • Study Flashcards
    • Pediatric Ophthalmology Education Center
    • PGY-1 and PGY-2 Resources
    • Resident Knowledge Exchange
    • Simulation in Resident Education
    • Clinical Education /
    • Book Excerpts /
    • Basic and Clinical Science Course - Excerpt
  • 2020–2021 BCSC Basic and Clinical Science Course™

    Go to Academy Store Learn more and Purchase.

    2 Fundamentals and Principles of Ophthalmology

    Part V: Ocular Pharmacology

    Chapter 16: Ocular Pharmacotherapeutics*

    Anti-inflammatory Drugs

    Ocular inflammation can be treated with medications administered topically, by local injection, by ocular implantation, or systemically. These agents are classified as glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), mast-cell stabilizers, antihistamines, or antifibrotics.

    Glucocorticoids

    Corticosteroids, or steroids, are applied topically to prevent or suppress ocular inflammation in trauma and uveitis, as well as after most ocular surgical procedures (Table 16-14). Subconjunctival, sub-Tenon, and intravitreal injections of steroids are used to treat more severe cases of ocular inflammation. Systemic steroid therapy is used to treat systemic immune diseases, such as giant cell arteritis, vision-threatening capillary hemangiomas in childhood, and severe ocular inflammation that is resistant to topical therapy. Intravenous methylprednisolone is sometimes used in short-term management of various orbital and neuro-ophthalmic conditions (see BCSC Section 5, Neuro-Ophthalmology, and Section 7, Oculofacial Plastic and Orbital Surgery). Corticosteroids are divided into 2 major groups, glucocorticoids and mineralocorticoids, on the basis of their predominant biological activities.

    Glucocorticoids induce cell-specific effects on lymphocytes, macrophages, polymorphonuclear leukocytes, vascular endothelial cells, fibroblasts, and other cells. In each of these cells, glucocorticoids must

    • penetrate the cell membrane

    • bind to soluble receptors in the cytosol

    • allow the translocation of the glucocorticoid receptor complex to nuclear-binding sites for gene transcription

    • induce or suppress the transcription of specific messenger RNA (mRNA)

    The proteins produced in the eye under the control of these mRNAs are not known, and only resultant effects have been described.

    At the tissue level, glucocorticoids prevent or suppress local hyperthermia, vascular congestion, edema, and the pain of initial inflammatory responses, whether the cause is traumatic (radiant, mechanical, or chemical), infectious, or immunologic. They also suppress the late inflammatory responses of capillary proliferation, fibroblast proliferation, collagen deposition, and scarring.

    At the biochemical level, the most important effect of anti-inflammatory drugs may be the inhibition of arachidonic acid release from phospholipids (see the following section). Liberated arachidonic acid is otherwise converted into PGs, PG endoperoxides, leukotrienes, and thromboxanes, which are potent mediators of inflammation. Glucocorticoids also suppress the liberation of lytic enzymes from lysozymes.

    The effects of glucocorticoids on immune-mediated inflammation are complicated. Glucocorticoids do not affect the titers of either immunoglobulin E (IgE), which mediates allergic mechanisms, or immunoglobulin G (IgG), which mediates autoimmune mechanisms. Also, glucocorticoids do not appear to interfere with normal processes in the afferent limb of cell-mediated immunity, as in graft rejection. Instead, they interfere with the subsequent efferent limb of the immune response. For example, glucocorticoids prevent macrophages from being attracted to sites of inflammation by interfering with the cells’ response to lymphocyte-released migration-inhibiting factor. Glucocorticoids administered for systemic effect cause sequestration of lymphocytes, especially the T lymphocytes that mediate cellular immunity. However, the posttranscriptional molecular mechanisms of these responses remain unknown. BCSC Section 9, Uveitis and Ocular Inflammation, discusses immune responses in detail.

    Table 16-14 Topical Anti-inflammatory Drugs

    Adverse effects

    Glucocorticoids may cause several adverse effects in the eye and elsewhere in the body.

    Complications in the eye include

    • glaucoma

    • posterior subcapsular cataracts

    • exacerbation of bacterial and viral (especially herpetic) infections through suppression of protective immune mechanisms

    • fungal infection

    • ptosis

    • mydriasis

    • scleral melting

    • eyelid skin atrophy

    • pseudohypopyon from intraocular injection

    • central serous chorioretinopathy

    In the body, oral doses can cause

    • suppression of the pituitary–adrenal axis

    • gluconeogenesis resulting in hyperglycemia, muscle wasting, and osteoporosis

    • redistribution of fat from the periphery to the trunk

    • CNS effects, such as euphoria

    • insomnia

    • aseptic necrosis of the hip

    • peptic ulcer

    • diabetes mellitus

    • occasionally psychosis

    Elderly patients have particular difficulty taking long-term systemic steroids. For example, the adverse effect of proximal muscle wasting may make it difficult for these patients to climb stairs. Osteoporosis, another adverse effect of glucocorticoids, exacerbates the risk of falls and fractures for these patients, who are generally at an increased risk of both. Elderly patients with inflammatory diseases may require a steroid-sparing regimen.

    Steroid-induced elevation in IOP may occur with topical, intraocular, periocular, nasal, and systemic glucocorticoid therapies. The exact mechanism by which steroids diminish aqueous outflow through the TM remains unknown but may be related to deposition of glycosaminoglycans in the TM.

    Individual response to steroids is dependent on the duration, potency, and frequency of therapy and the route of administration of the drug used. Steroid-induced IOP elevation almost never occurs in less than 5 days and is infrequent in less than 2 weeks of use. However, failure of IOP to rise after 6 weeks of therapy does not ensure that a patient will maintain normal IOP after several months of therapy. For this reason, monitoring of IOP at periodic intervals is required throughout the course of long-term steroid therapy to prevent iatrogenic glaucomatous nerve damage. Steroid-induced elevations in IOP are usually reversible by discontinuing therapy if the drug has not been used longer than 1 year; however, if therapy has continued for 18 months or more, permanent elevations of pressure are common.

    Table 16-15 lists the anti-inflammatory and IOP-elevating potencies of 6 steroids used in ophthalmic therapy. The anti-inflammatory potencies were determined by an in vitro assay of inhibition of lymphocyte transformation, and the IOP effects were determined by tests in individuals already known to be highly responsive to topical dexamethasone. However, until all these drugs are compared in a model of ocular inflammation relevant to human disease, no conclusion can be reached about the observed dissociation of effects. The lower-than-expected effect on pressure with some of these drugs may be explained by more rapid metabolism of fluorometholone in the eye compared with dexamethasone and by the relatively poor penetration of medrysone. The efficacy of these drugs for intraocular inflammation may be similarly reduced.

    CLINICAL PEARL

    The rates of IOP spikes for various steroids differ and depend on the potency, formulation, and delivery of the particular drug. When patients are treated with steroids, it is important that ophthalmologists consult the literature for information on individual agents and their effects on IOP.

    When a steroid-induced pressure rise is suspected but continued steroid therapy is warranted, the physician faces the following choices:

    • continue the same treatment and closely monitor the status of the optic nerve

    • attempt to offset the pressure rise with other drugs or treatments

    • reduce the potency, concentration, or frequency of the steroid used while monitoring both pressure and inflammation

    • consider a steroid-sparing alternative

    Table 16-15 Comparison of Anti-inflammatorya and IOP-Elevatingb Potencies

    Immunomodulatory therapy (IMT) is an important component in the management of ocular inflammation, avoiding the toxicity associated with long-term corticosteroid therapy. IMT drugs are classified as antimetabolites, inhibitors of T-cell signaling, alkylating agents, and biologic response modifiers. Biologic response modifiers inhibit various cytokines, which are active in inflammation. See Table 16-16 for a summary of this class of medications and also BCSC Section 9, Uveitis and Ocular Inflammation.

    • Jabs DA. Immunosuppression for the uveitides. Ophthalmology. 2018;125(2):193–202.

    Specific drugs and regimens

    Appropriate selection from the available corticosteroid drugs, formulations, and dosage regimens are contingent on the clinical situation. Steroids can be administered topically, periocularly, intravenously, or intravitreally (Table 16-17). All corticosteroids may exacerbate infections and lead to ocular adverse effects. Recent research in corticosteroids has focused on medications that can be used intraocularly and periocularly as well as developing drugs with decreased effect on IOP. As a general rule, however, the more potent the steroid, the more prevalent and severe are the adverse events.

    Rimexolone, 1%, is a synthetic topical steroid designed to minimize IOP elevations, similar to fluorinated steroids. Elevated IOP has been reported with this medication, but it is rare. Ocular adverse effects still include secondary glaucoma and posterior subcapsular cataracts. Systemic adverse effects, including headache, hypotension, rhinitis, pharyngitis, and taste perversion, occur in fewer than 2% of patients.

    Loteprednol etabonate, 0.5%, is structurally similar to other steroids but lacks a ketone group at position 20. Loteprednol etabonate, 0.2%, is marketed for the temporary treatment of allergic conjunctivitis. The combination drug loteprednol etabonate (0.5%)/tobramycin (0.3%) is approved for superficial bacterial infections of the eye with inflammation. Studies have shown that in corticosteroid responders treated with loteprednol, the incidence of clinically significant IOP elevation is low.

    Difluprednate is a difluorinated derivative of prednisolone. Its glucocorticoid receptorbinding affinity and corneal penetration are greatly enhanced by modification of the glucocorticoid molecule with the addition of fluorine atoms and ester groups at several carbon positions. Difluprednate is formulated as a stable oil-in-water emulsion to achieve consistent dose uniformity compared with suspensions, regardless of bottle storage position or shaking before use. Although the strong therapeutic potency of difluprednate emulsion is desirable, IOP increase has been reported anecdotally and clinically to be greater than that of other moderate to strong topical steroids.

    Fluocinolone acetonide is available in 2 intraocular devices. A nonbiodegradable implant with 0.59 mg of fluocinolone acetonide surgically placed in the pars plana region was approved by the FDA for the treatment of chronic noninfectious posterior uveitis. It is designed to release fluocinolone acetonide at a nominal initial rate of 0.6 µg/d, decreasing over the first month to a steady state between 0.3 and 0.4 µg/d over approximately 30 months. Another 0.19-mg nonbiodegradable implant, delivered by intravitreal injection, was FDA approved for the treatment of diabetic macular edema in patients who are not steroid responders. It releases fluocinolone acetonide at an average rate of 0.2 µg/d for 36 months.

    Table 16-16 Immunomodulatory Medications in the Treatment of Uveitis

    Table 16-17 Usual Route of Corticosteroid Administration in Ocular Inflammation

    A 0.7-mg dexamethasone biodegradable polymer matrix for injection into the vitreous cavity was approved for the treatment of macular edema secondary to retinal vein occlusion, noninfectious posterior uveitis, and diabetic macular edema. The polymer dissolves, and dexamethasone is slowly released for up to 6 months, with clinical efficacy lasting at least 3 months.

    A 40-mg/mL preservative-free triamcinolone acetonide injectable suspension was FDA approved for intraocular use. Its indications include visualization during vitrectomy and treatment of sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions that do not respond to topical corticosteroids.

    • Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics, I: the effect of dexamethasone in the normal eye. Arch Ophthalmol. 1963;70(4):482–491.

    • Armaly MF. Effect of corticosteroids on intraocular pressure and fluid dynamics, II: the effect of dexamethasone in the glaucomatous eye. Arch Ophthalmol. 1963;70(4):492–499.

    • Donnenfeld ED. Difluprednate for the prevention of ocular inflammation postsurgery: an update. Clin Ophthalmol. 2011;5:811–816.

    • Mulki L, Foster CS. Difluprednate for inflammatory eye disorders. Drugs Today (Barcelona). 2011;47(5):327–333.

    Excerpted from BCSC 2020-2021 series: Section 2 - Fundamentals and Principles of Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.

  • Most Commented
    Loading, please wait...
    There are no comments available.
    Most Viewed
    Loading, please wait...
    Most Viewed content is not available.
  • The Academy Store
    Transitioning Your Practice: Retiring, Selling or Buying a Practice (Free Member Webinar)
    How to Build a Patient-First Culture (Free Member Webinar)
    2022 IRIS Registry (Intelligent Research in Sight) Preparation Kit
    Advances in Medical and Surgical Management: The 2022 Update on Glaucoma
    Presbyopia-Correcting IOLs
    2022 Codequest - Multistate (Recorded March 29)
    2022 Codequest Virtual (Multistate)
    Retina Patient Education Video Collection
    Cataract and Refractive Surgery Patient Education Video Collection
    Glaucoma Patient Education Video Collection
    Oculoplastics Patient Education Video Collection
    Pediatrics Patient Education Video Collection
    2022 Coding Coach: Complete Ophthalmic Coding Reference 
    2022 CPT: Complete Pocket Ophthalmic Reference
    2022 Retina Coding: Complete Reference Guide
    2022 Fundamentals of Ophthalmic Coding
    2022 CPT Professional Edition 
    2022 HCPCS Level ll Professional Edition
    2022 Coding Assistant for Subspecialties 
    2022 Coding Assistant: Cataract and Anterior Segment
    2022 Coding Assistant: Cornea
    2022 Coding Assistant: Glaucoma
    2022 Coding Assistant: Oculofacial
    2022 Coding Assistant: Pediatrics/Strabismus
    2022 ICD-10-CM for Ophthalmology: The Complete Reference 
    Practical Ophthalmology: Manual for Beginning Residents, 8th Edition
    Practical Ophthalmology: Manual for Beginning Residents, 8th Edition eBook
    Practical Ophthalmology: Manual for Beginning Residents, 8th Edition Print + eBook
    Practical Ophthalmology, 8th Edition
    2021-2022 Basic and Clinical Science Course Complete Set
 
  • Contact Us
  • About the Academy
  • Jobs at the Academy
  • Financial Relationships with Industry
  • Medical Disclaimer
  • Privacy Policy
  • Terms of Service
  • Help
  • For Advertisers
  • For Media
  • Ophthalmology Job Center

OUR SITES

  • EyeWiki
  • International Society of Refractive Surgery

FOLLOW THE ACADEMY

Medical Professionals

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube

Public & Patients

  • Facebook
  • Twitter
  • Instagram
  • YouTube

Museum of the Eye

  • Facebook
  • Twitter
  • Instagram
  • YouTube
  • Trip Advisor
  • Yelp
© American Academy of Ophthalmology 2022