Investigators describe clinical outcomes associated with the use of topical difluprednate in treating uveitic cystoid macular edema (CME).

Study design

This retrospective, interventional case series examined records from 58 patients (72 eyes) with uveitic CME who were treated at a single tertiary care uveitis center. All patients were treated with difluprednate 0.05% ophthalmic solution, either alone or in combination with systemic immunosuppressive medications.

Outcomes

The majority of patients showed improvement in CME after 30 days. Of eyes on difluprednate alone, 76% showed improvement and 48% had resolution of CME. By 90 days, over 80% of patients with improvement or resolution of CME had maintained that benefit.

By 30 days, patients on concomitant systemic immunosuppressive therapy with difluprednate showed less improvement in macular central subfield thickness (CST) than those on difluprednate alone (6% vs 17%).

Approximately 11% and 21% of patients developed elevated IOP above 24 mm Hg at 30 and 90 days, respectively.

Limitations

The systemic therapy group had less improvement in CST, possibly due to more severe disease, which may indicate treatment bias. The combination group also had lower initial CST and more vitreous haze at baseline, which may also explain why they showed less change than the difluprednate-only group.

Sixteen eyes had glaucoma at baseline (9 eyes with prior surgery), so it is possible that IOP elevation may be underestimated in patients treated with difluprednate. The study was retrospective and the sample size was small.

Clinical significance

Difluprednate is a reasonable alternative to corticosteroid injections for the treatment of uveitic macular edema. However, physicians should monitor patients closely for IOP elevation over the course of treatment.