Real world use of loteprednol etabonate ophthalmic gel 0.5% in cases representative of comorbid pathologies responding to minimally invasive glaucoma surgery

Abstract

Purpose

With the increasing use of minimally invasive surgical techniques for intraocular pressure (IOP) lowering in glaucoma patients, there is a need to examine best practices regarding the postoperative management of these patients. Corticosteroids, though effective in controlling postoperative ocular pain and inflammation, present distinct challenges in glaucoma surgery patients, as their use can be associated with IOP elevation. Loteprednol etabonate (LE) is an ocular corticosteroid designed to have an improved safety profile relative to other corticosteroids.

Methods

We report here a representative selection of cases in which patients were successfully treated with LE ophthalmic gel 0.5% (LE gel) following a variety of minimally invasive glaucoma surgery (MIGS) procedures. Cases included patients undergoing various procedures including a Trabectome combined with cataract surgery; micro-stent surgery (iStent) combined with cataract surgery; supraciliary CyPass Micro-Stent placement combined with cataract surgery; Kahook Dual Blade goniotomy; and ab interno canaloplasty using the iTrack catheter.

Observations

In all cases, use of LE gel during the postoperative period appeared effective and safe in reducing inflammation and controlling pain. No adverse events or IOP elevations were noted, even in those patients continuing use of LE gel past the postoperative period for longer than six months with documented follow-up. In two cases, patients with elevated IOP using either prednisolone or difluprednate postoperatively were switched to LE gel, with a subsequent reduction in IOP.

Conclusions

This selection of cases involving patients undergoing MIGS suggests that LE gel may be an effective and safe option for treating postoperative inflammation and pain following such procedures with minimal to no effect on IOP or other negative sequalae.

Keywords:

• loteprednol etabonate
• minimally invasive glaucoma surgery
• intraocular pressure
• postoperative pain and inflammation
• safety

Acknowledgments

The authors acknowledge the writing assistance of Rachel Hathcock, RN of Churchill Communications, funded by Bausch + Lomb, Incorporated.

Disclosure

JD Sheppard serves as a consultant for Alcon, Bausch + Lomb, a division of Bausch Health US, LLC, and NeoMedix. He also reports grants from Bausch + Lomb, for the conduct of independent research studies. IP Singh receives honoraria for speaking and consulting for Bausch + Lomb. He is also a speaker and consultant for Allergan, Alcon, Glaukos, Ellex, and New World Medical. The authors report no other conflicts of interest in this work.