A retrospective analysis of intraocular pressure changes after cataract surgery with the use of prednisolone acetate 1% versus difluprednate 0.05%

PURPOSE To compare the effect of topical prednisolone acetate 1% (PA) used after routine cataract surgery to the effect of difluprednate 0.05% (DFBA) used for the same indication on intraocular pressure (IOP). METHODS An electronic query was created to gather information from all cataract surgeries between January 2010 and January 2015 within the electronic health record database at Barnet Dulaney Perkins, a multicenter, multiphysician private practice in Phoenix, Arizona. Information collected included age, sex, diabetes status, glaucoma history, medication regimen (use of PA or DFBA), and IOP before surgery, 5-10 days postoperatively (TP1) and 3-6 weeks postoperatively (TP2). Postoperative IOP measurements were compared to baseline IOP measurement in each patient. RESULTS Regardless of steroid used, all patients in this study experienced an increase in IOP within TP1 and returned to baseline IOP (±2.0 mmHg) by TP2. Patients who received DFBA showed a statistically significant increase in IOP at TP1 compared to those on PA (P<0.001) with the mean IOP an average 0.60 mmHg higher (95% CI =0.3, 0.9). The odds ratio of a clinically significantly increased IOP at TP1 (defined as overall IOP ≥21 mmHg and an increase of ≥10 mmHg) in DFBA-treated patients was 1.84 (95% CI =1.4, 2.6). In patients treated with PA, 3% reached a significantly increased IOP, compared to 4.4% of patients in the DFBA group (P<0.05). Risk factors for increased IOP were identified, and include advanced age (>75) (P<0.005) and a history of glaucoma (P<0.001). CONCLUSION In postoperative cataract patients, use of DFBA increased the risk of a clinically significant IOP increase.