Difluprednate shows promise as adjuvant for pediatric uveitis

This retrospective study conducted in pediatric patients with uveitis found that topical difluprednate (Durezol) was effective at controlling anterior segment inflammation and reducing cystoid macular edema (CME) when used as an adjuvant to systemic immunomodulatory therapy. However, the authors report in the May issue of the American Journal of Ophthalmology that this was accompanied by a high rate of steroid-induced IOP elevation and cataract formation. Therefore, they recommend close monitoring of pediatric patients receiving difluprednate.

The study included 14 noninfectious uveitis patients age 17 and younger treated with difluprednate at a referral uveitis clinic and a referral pediatric ophthalmology clinic, with at least six months follow-up.

A significant (at least two-grade decrease or decrease to 0 in anterior segment cell) reduction in anterior segment inflammation was observed during treatment with topical difluprednate in 88 percent of eyes (22/25) when used as an adjuvant to systemic immunomodulatory therapy. In addition, CME associated with uveitis improved in response to topical difluprednate therapy in 78 percent of eyes with CME (7/9).

However, a significant increase in IOP (gain of 10 mmHg or greater from baseline and IOP of 24 mmHg or greater) was seen in 50 percent of eyes (13/26) and in 50 percent of patients (7/14). Two patients (three eyes) required glaucoma surgery.

Cataract formation or progression was observed in 39 percent of eyes (10/26) and in 43 percent of patients (6/14). Three patients (five eyes) required cataract surgery.

The authors note that the rate of cataract formation and elevated IOP in this study is higher than has been reported in larger studies of pediatric uveitis. They speculate that this could be the result of selection bias or increased potency of difluprednate.

All patients with CME responsive to difluprednate in this study previously had been treated with topical prednisolone acetate without similar resolution of CME. The authors say their results suggest that the intraocular penetration of difluprednate, the potency of difluprednate, or both are significantly higher than may be expected with other topical therapies and are more consistent with that typically seen with periocular administration of corticosteroid.