Treatment with Difluprednate Similar to Prednisolone Acetate After AGV implantation

Ying Han, MD, PhD

New findings suggest postoperative treatment with 0.05% difluprednate after Ahmed glaucoma valve (AGV) implantation led to similar intraocular pressure (IOP) and fewer glaucoma medications compared with treatment with 1% prednisolone acetate.

The data additionally indicate the rate of treatment success and surgical complications were comparable between the 2 groups during the first year of follow-up, according to study investigators.

Led by Ying Han, MD, PhD, Medical Director, Glaucoma Clinic, University of California San Francisco, the study aimed to evaluate the effect of postoperative topical prednisolone acetate and difluprednate on survival outcomes of AGV implantation. The retrospective, comparative case series consisted of a study population with 102 eyes of 90 patients. This included 52 eyes that received 1% prednisolone acetate (Pred Forte) and 50 eyes that received 0.05% difluprednate (Durezol).

The team retrospectively reviewed the medical records of consecutive patients who underwent AGV implantation at the University of San Francisco. The individuals in the prednisolone acetate group received 1% prednisolone acetate 6 to 8 times per day taped over 5 to 6 months postoperatively. Those in the difluprednate group received 0.05% difluprednate 4 times daily tapered over 4 months postoperatively.

The main outcome measures for the study included IOP, number of glaucoma medications, visual acuity (VA), postoperative complications, and the rate of treatment success. At the 1-year mark, the IOPs were 12.4 ± 3.7 mmHg in the difluprednate group and 13.0 ± 4.0 mmHg in the prednisolone acetate group (P = 0.49).

The data show the numbers of glaucoma medications were 0.72 ± 0.71 in the difluprednate group and 1.09 ± 0.91 in the prednisolone acetate group (P = 0.04). Reductions from baseline of 2.5 ± 1.0 glaucoma medications in the difluprednate group and 1.8 ± 1.6 glaucoma medications in the prednisolone acetate group (P = 0.01) were observed by investigators.

Additionally, the logarithm of the minimum angle of resolution VAs were reported as 0.55 ± 0.80 in the difluprednate group and 0.59 ± 0.65 in the prednisolone acetate group after 1 year of follow-up (P = 0.81). Meanwhile, the cumulative probabilities of success were 95.8% in the difluprednate group and 93.5% in the prednisolone acetate group at the 1-year mark (P = 0.61).

Investigators noted postoperative complications occurred in 4 eyes (7.7%) in the difluprednate group and 6 eyes (12%) in the prednisolone acetate group (P = 0.52).

The abstract, “Surgical Outcomes of Ahmed Glaucoma Valve Implantation with Postoperative Use of Prednisolone Acetate versus Difluprednate,” was published in Ophthalmology Glaucoma.