Difluprednate for the Treatment of Postoperative Hypotony following Complicated Retinal Detachment Surgery
Investigative Ophthalmology & Visual Science
Purpose : Severe hypotony following successful complex retinal detachment (RD) repair can progress to phthisis bulbi without intervention, even in the setting of long-term postoperative intraocular tamponade with silicone oil. It is also known that the use of periocular and intraocular steroids has been seen to induce an elevated intraocular pressure (IOP) response in some eyes. This study sought to assess the impact of topical difluprednate on raising intraocular pressure in patients with hypotony following surgical repair of a complex-RD.
Methods : A retrospective, consecutive case series was conducted on patients treated with difluprednate after successful complex RD repair at Associated Retinal Consultants (ARC, Royal Oak, Michigan) from January 2013 to June 2021. Patients were identified as having had complex RD repair by Current Procedural Terminology (CPT) code.
Results : Medical records of 230 patients were reviewed and 39 eyes of 39 patients were found to develop hypotony (IOP < 8 mmHg), despite having complete retinal reattachment and not having cyclitic membranes, at least 1 month after their last surgery. The majority of patients were left with long term silicone oil tamponade (26 of 39, 66.6%) and had required a retinectomy at the time of surgical repair (30 of 39, 76.9%). Patients presented with hypotony an average of 41 days after their last surgery (6-167 days). After initiation of topical difluprednate, there was a statistically significant increase in mean IOP (5.6mmHg) and at the patient’s final follow up (8.6 mmHg, p=0.032).The average follow-up was 833 days after difluprednate initiation (range 76-2406 days). One patients progressed to phthisis bulbi, and all remained with complete retinal attachment at the last follow-up visit.
Conclusions : Topical difluprednate therapy for hypotony following successful complex RD repair resulted in a statistically significant increase in IOP and prevented phthisis bulbi in a majority of patients.
Govindaraju V, Omari A, Jung D, Koustas K, Saleem Z, Shields R, et al [Williams GA, Hassan T] Difluprednate for the treatment of postoperative hypotony following complicated retinal detachment surgery. Invest Ophthalmol Vis Sci. 2022 June;63(7):3462 – F0362.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.