Prednisolone acetate/unspecified corticosteroids
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Glaucoma: case report A 23-year-old woman developed glaucoma during treatment with prednisolone acetate and unspecified oral corticosteroids for idiopathic panuveitis. The woman, who had idiopathic uveitis, was referred to the Glaucoma Department with intraocular pressure (IOP) of 56mm Hg in the left eye and 58mm Hg in the right eye. She was initially diagnosed with idiopathic panuveitis approximately 1 year earlier. She had been treated with oral corticosteroids [specific drug not stated] and topical prednisolone acetate 1% ophthalmic suspension [Pred Forte] 4 times a day during acute flares. Forty-two days prior to the presentation, she had started receiving IOP-lowering medications comprising dorzolamide/timolol, latanoprost and brimonidine. She was also on azathioprine in an attempt to control the panuveitis. Upon presentation, she had clear corneas, quiet anterior chambers and mild vitreous debris without obvious active inflammation. The increased IOP was considered secondary to corticosteroid-induced glaucoma. The woman received one set of all her ocular hypotensive drops in both eyes which included latanoprost, dorzolamide/timolol and brimonidine. She was also given acetazolamide. One hour afterwards, the IOP was 34mm Hg in the left eye and 50mm Hg in the right eye. After thorough discussion, she consented to a combined Kahook and Gonioscopy-assisted transluminal trabeculotomy (GATT) procedure. The right eye operation was performed immediately and the left eye operation was performed 2 weeks later. One drop of prednisolone acetate 1% ophthalmic suspension [Pred Forte] was placed in the surgical eye. On postoperative day 1, the IOP was 11mm Hg in the left eye and 8mm Hg in the right eye. Her vision was 20/20-3 in the left eye and 20/30 in the right eye. Anterior chamber red and white blood cells were noted on postoperative day 1 with a 2mm hyphema in the right eye (a common postoperative complication). Within one week, her IOP had rebounded to 20mm Hg in the right eye and 34mm Hg in the left eye, with uncorrected vision of 20/20 in both the eyes. At 1 month after the operation, her IOP was found to be decreased to 13mm Hg in both the eyes while continuing dorzolamide/timolol and brimonidine. At 2 months after the operation, brimonidine was stopped and dorzolamide/timolol was continued. At 12 months after the operation, her inflammation was controlled and IOP was 14mm Hg in the right eye and 15mm Hg in the left eye. She was taking one drop of prednisolone acetate [Pred Forte] four times daily, full treatment dose of azathioprine and one drop of dorzolamide/timolol bilaterally twice daily. Her uncorrected vision was excellent at 20/20 bilaterally. She was seen 1–2 times per month in the 12-month post-oparative period and she did not experience any new significant visual symptoms nor did she have any further complaints. Widder JR, et al. Combining Ab Interno Kahook Trabeculectomy with Gonioscopy-Assisted Transluminal Trabeculotomy Reduces Intraocular Pressure. Military Medicine 803499136 184: 934-936, No. 1
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