Do reducing regimens of fluorometholone for paediatric ocular surface disease cause glaucoma?

Trends in Topical Prescriptional Therapy for Old Patients With Dry Eye Disease in Six Major Areas of China: 2013-2019

The prevalence of dry eye disease (DED) in old patients are high, corresponding to a substantial economic burden. In this cross-sectional study, we analyzed the trends in the topical prescriptional treatment of old patients with DED in six major areas of China. Information on topical drug prescriptions for DED patients aged above 60 years was extracted from the Hospital Prescription Analysis Cooperative Program of China database. Trends in yearly prescriptions and cost were analyzed. The data were further stratified by patient age and sex, drug class, and specific drug. A total of 130,734 prescriptions from 52 hospitals located in six major areas of China were analyzed. The number of prescripptions per year for patients with DED increased from 13,308 in 2013 to 22,074 in 2019, with a corresponding increase in cost of all topical drugs from 1,490,014 Chinese Yuan (CNY) to 2,618,206 CNY. Drugs for the treatment of DED accounted for the largest proportion of the total cost in each year. Ocular lubricants were the main pharmacotherapy agent. Sodium hyaluronate use increased over time, and the drug was used by 65.9% of patients by the end of the study. Pranoprofen was the second most frequently used drug. The most frequently used drugs for co-incident disease were antimicrobials. Treatment patterns for DED haven’t changed, and the most frequently used drug combination was sodium hyaluronate and pranoprofen. In summary, prescription for old patients with DED and the cost of treatment are increasing. Ocular lubricants are the main treatment option, while sodium hyaluronate is the most frequently used drug. The observed trends can lead to more efficient allocation of health care resources in China.

Steroid-induced glaucoma in the pediatric population

Steroid medications may cause elevation of intraocular pressure, sometimes with permanent damage to the optic nerve. These therapies, via various routes of administration, are commonly prescribed for children, but the potential sequelae of elevated intraocular pressure and glaucomatous optic nerve damage can be even more severe and devastating in children than in adults. This review discusses the pathophysiology and potential risk factors, including the impact of intraocular pressure elevation via the different common routes of administration of steroids, clinical evaluation, and management of steroid response and steroid-induced glaucoma in children.

Reasons for Early Ocular Hypertension after Uneventful Cataract Surgery

Purpose

To discuss the reasons for and measurements of early ocular hypertension after uneventful phacoemulsification and intraocular lens (IOL) implantation.

Methods

This was a retrospective review of patients who had early ocular hypertension after cataract surgery from a single-surgeon practice that medications failed to control or required additional surgery from September 2011 to January 2013.

Results

Of the 1270 eyes that had cataract surgery by one surgeon in our department in 16 months, 12 (9.4‰) eyes of 12 patients met the inclusion criteria. The mean postoperative intraocular pressure (IOP) peak was 41 (range 32-62) mm Hg. The median time of initial onset after cataract surgery was 3.5 days (range 1-60 days). Six eyes had antiglaucoma surgery history. Ahmed valve implantation with mitomycin C (MMC) was applied to 4 eyes. Two eyes underwent 5-fluorouracil needling revision with MMC. The IOP dropped in 3 eyes only in the case that the conventional topical corticosteroid agent was stopped, diagnosed as steroid responders. One eye of a patient with diabetes mellitus (DM) developed pseudophakic pupillary block angle-closure glaucoma due to the plasma glucose fluctuations. The IOP was controlled after Nd:YAG laser iridotomies. Residual cortex caused ocular hypertension in 2 eyes and surgical aspirations were performed. Following monitoring of IOP for 6 to 24 months, all eyes were within the normal range.

Conclusions

Patients with history of glaucoma surgery; high myopia, especially in young age; and DM merit particular observation and treatment for possible IOP elevation following cataract surgery.