Topical glucocorticoids in ophthalmology: a comparative analysis of efficacy and safety
https://doi.org/10.21516/2072-0076-2023-16-2-166-172
Abstract
The symptoms of most pathological conditions in ophthalmology are based on inflammations of varying severity. Valuable tools against inflammation are topical glucocorticoids (tGCs), whose molecules are able to actively overcome biological membranes and ensure a rapid clinical response. The use of tGCs is accompanied by a wide range of effects, including side effects, a rise in intraocular pressure being one of the most significant ones. The review focuses on a comparative analysis of the efficacy and safety of various tGCs, including “soft steroids”. We show the relationship between the structure of the drugs, their pharmacodynamic effects and the possibility of being used in various eye diseases.
About the Authors
S. K. Zyryanov
Peoples' Friendship University of Russia;
City Clinical Hospital No. 24
Russian Federation
Russian Federation
Sergey K. Zyryanov, Dr. of Med. Sci., professor, head of the department of general and clinical pharmacology, 6, Miklukho-Maclaya Str., Moscow, 117198;
deputy chief physician, 10, Pestsovaya St., Moscow, 127015
O. I. Butranova
Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Olga I. Butranova, Cand. of Med. Sci., associate professor, department of general and clinical pharmacology,
6, Miklukho-Maclaya Str., Moscow, 117198
References
1. Varu DM, Rhee MK, Akpek EK, et al. Conjunctivitis preferred practice pattern®. Ophthalmology. 2019 Jan;126 (1): 94–169. doi: 10.1016/j.ophtha.2018.10.020
2. Lin A, Rhee MK, Akpek EK, et al. Bacterial keratitis preferred practice pattern®. Ophthalmology. 2019; 126 (1): 1–55. doi:10.1016/j.ophtha.2018.10.018
3. Ghadiri N, Reekie IR, Gordon I, et al. Systematic review of clinical practice guidelines for uveitis. BMJ Open Ophthalmology. 2023; 8: e001091. doi: 10.1136/bmjophth-2022-001091
4. De Loof H, De Win E, Moens N, et al. Overprescribing of topical ocular corticosteroids and antibiotics in out-of-hours primary care in Belgium. Drug Healthc Patient Saf. 2021; 13: 229–32. doi: 10.2147/DHPS.S339141
5. Khoo P, Cabrera-Aguas M, Watson SL. Topical steroids as adjunctive therapy for bacterial keratitis: Evidence from a retrospective case series of 313 cases. Asia Pac J Ophthalmol (Phila). 2020; 9 (5): 398–403. doi:10.1097/APO.0000000000000320
6. Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, et al. Indication-prescription study for the management of conjunctivitis in a Colombian population. Int Ophthalmol. 2023; 43 (1): 83–93. doi: 10.1007/s10792-022-02390-7
7. Shekhawat NS, Shtein RM, Blachley TS, Stein JD. Antibiotic prescription fills for acute conjunctivitis among enrollees in a large United States managed care network. Ophthalmology. 2017; 124 (8): 1099–107. doi: 10.1016/j.ophtha.2017.04.034
8. Henderson LA, Zurakowski D, Angeles-Han ST, et al. Childhood Arthritis And Rheumatology Research Alliance (CARRA) registry investigators. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J. 2016; 14 (1): 9. doi: 10.1186/s12969-016-0069-5
9. Prinz J, Maffulli N, Fuest M, et al. Efficacy of topical administration of corticosteroids for the management of dry eye disease: Systematic review and meta-analysis. Life. 2022; 12 (11): 1932. https://doi.org/10.3390/life12111932
10. Liu SH, Saldanha IJ, Abraham AG, et al. Topical corticosteroids for dry eye. Cochrane Database Syst Rev. 2022; 10(10): CD015070. doi: 10.1002/14651858.CD015070.pub2
11. Ling J, Chan BC, Tsang MS, et al. Current advances in mechanisms and treatment of dry eye disease: Toward anti-inflammatory and immunomodulatory therapy and traditional chinese medicine. Front Med (Lausanne). 2022; 8: 815075. doi: 10.3389/fmed.2021.815075
12. Holland EJ, Fingeret M, Mah FS. Use of topical steroids in conjunctivitis: A review of the evidence. Cornea. 2019; 38(8): 1062-7. doi: 10.1097/ICO.0000000000001982
13. Chang YS, Weng SF, Wang JJ, Jan RL. Temporal association between topical ophthalmic corticosteroid and the risk of central serous chorioretinopathy. Int J Environ Res Public Health. 2020; 17 (24): 9455. doi:10.3390/ijerph17249455
14. Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. 2010; 117 (7): 1436–41. doi: 10.1016/j.ophtha.2009.12.003
15. Zhao L, Sun YJ, Pan ZQ. Topical steroids and antibiotics for adult blepharokeratoconjunctivitis (BKC): A Meta-analysis of randomized clinical trials. J Ophthalmol. 2021; 2021: 3467620. doi:10.1155/2021/3467620
16. Dey KK, Ghosh M. Understanding the structure and dynamics of antiinflammatory corticosteroid dexamethasone by solid state NMR spectroscopy. RSC Adv. 2020; 10 (61): 37564–75. doi: 10.1039/d0ra05474g
17. Zyryanov S.K., Butranova O.I. Topical glucocorticosteroids: efficacy and safety in gynecology. Obstetrics and gynecology. 2021; 5: 166–72 (In Russ.). doi: 10.18565/aig.2021.5.166-172
18. Onyimba CU, Vijapurapu N, Curnow SJ, et al. Characterisation of the prereceptor regulation of glucocorticoids in the anterior segment of the rabbit eye. J Endocrinol. 2006; 190 (2): 483–93. doi: 10.1677/joe.1.06840
19. Sulaiman RS, Kadmiel M, Cidlowski JA. Glucocorticoid receptor signaling in the eye. Steroids. 2018; 133: 60–6. doi: 10.1016/j.steroids.2017.11.002
20. Dismuke WM, Klingeborn M, Stamer WD. Mechanism of fibronectin binding to human trabecular meshwork exosomes and its modulation by dexamethasone. PLoS One. 2016 Oct; 11 (10): e0165326. doi: 10.1371/journal.pone.0165326
21. Jain A, Wordinger RJ, Yorio T, Clark AF. Role of the alternatively spliced glucocorticoid receptor isoform GRβ in steroid responsiveness and glaucoma. J Ocul Pharmacol Ther.; 30 (2–3): 121–7. doi: 10.1089/jop.2013.0239
22. Kathirvel K, Haribalaganesh R, Krishnadas R, et al. A comparative genomewide transcriptome analysis of glucocorticoid responder and non-responder primary human trabecular meshwork cells. Genes (Basel). 2022 ; 13 (5): 882. doi: 10.3390/genes13050882
23. Caramori G, Mumby S, Girbino G, Chung KF, Adcock IM. Corticosteroids. Nijkamp and Parnham's Principles of Immunopharmacology. 2019: 661–88. doi: 10.1007/978-3-030-10811-3_32
24. Cutolo CA, Barabino S, Bonzano C, Traverso CE. The use of topical corticosteroids for treatment of dry eye syndrome. Ocul Immunol Inflamm. 2019; 27 (2): 266–75. doi: 10.1080/09273948.2017.1341988
25. Jinagal J, Gupta PC, Pilania RK, Ram J. Systemic toxicity of topical corticosteroids. Indian J Ophthalmol. 2019; 67 (4): 559–61. doi: 10.4103/ijo.IJO_1091_18
26. Vajaranant TS, Price MO, Price FW, et al. Visual acuity and intraocular pressure after Descemet's stripping endothelial keratoplasty in eyes with and without preexisting glaucoma. Ophthalmology. 2009; 116 (9): 1644–50. doi: 10.1016/j.ophtha.2009.05.034
27. Yakin M, Kumar A, Kodati S, Jones L, Sen HN. Risk of elevated intraocular pressure with Difluprednate in patients with non-infectious uveitis. Am J Ophthalmol. 2022; 240: 232–8. doi: 10.1016/j.ajo.2022.03.026
28. Sen P, Jain S, Mohan A, et al. Pattern of steroid misuse in vernal keratoconjunctivitis resulting in steroid induced glaucoma and visual disability in Indian rural population: An important public health problem in pediatric age group. Indian J Ophthalmol. 2019; 67 (10): 1650–5. doi: 10.4103/ijo.IJO_2143_18
29. Ugalahi MO, Ibukun FA, Olusanya BA, Baiyeroju AM. Intraocular pressure elevation following the use of topical dexamethasone ointment after squint surgery. J West Afr Coll Surg. 2022; 12 (1): 70–5. doi: 10.4103/jwas.jwas_26_22
30. Price MO, Feng MT, Scanameo A, Price FW Jr. Loteprednol Etabonate 0.5% Gel Vs. Prednisolone Acetate 1 % Solution after descemet membrane endothelial keratoplasty: Prospective randomized trial. Cornea. 2015; 34 (8): 853–8. doi: 10.1097/ICO.0000000000000475
31. Price MO, Price FW Jr, Kruse FE, Bachmann BO, Tourtas T. Randomized comparison of topical prednisolone acetate 1% versus fluorometholone 0.1 % in the first year after descemet membrane endothelial keratoplasty. Cornea. 2014; 33 (9): 880–6. doi: 10.1097/ICO.0000000000000206
32. Pleyer U, Ursell PG, Rama P. Intraocular pressure effects of common topical steroids for post-cataract inflammation: are they all the same? Ophthalmol Ther. 2013; 2 (2): 55–72. doi: 10.1007/s40123-013-0020-5
33. Musleh MG, Bokre D, Dahlmann-Noor AH. Risk of intraocular pressure elevation after topical steroids in children and adults: A systematic review. Eur J Ophthalmol. 2020; 30 (5): 856–66. doi: 10.1177/1120672119885050
34. Morrison E, Archer DB. Effect of fluorometholone (FML) on the intraocular pressure of corticosteroid responders. Br J Ophthalmol. 1984; 68 (8): 581–4. doi: 10.1136/bjo.68.8.581
35. Akingbehin AO. Comparative study of the intraocular pressure effects of fluorometholone 0.1% versus dexamethasone 0.1 %. Br J Ophthalmol. 1983; 67 (10): 661–3. doi: 10.1136/bjo.67.10.661
36. Al Hanaineh AT, Hassanein DH, Abdelbaky SH, El Zawahry OM. Steroidinduced ocular hypertension in the pediatric age group. Eur J Ophthalmol. 2018; 28 (4): 372–7. doi: 10.1177/1120672118757434
37. Kempen JH, Tekle-Haimanot R, Hunduma L, et al. Fluorometholone 0.1 % as ancillary therapy for trachomatous trichiasis surgery: Randomized clinical trial. Am J Ophthalmol. 2019; 197: 145-55. doi: 10.1016/j.ajo.2018.09.017
38. Fakhraie G, Vahedian Z, Zarei R, et al. Intraocular pressure trend following myopic photorefractive keratectomy. Int Ophthalmol. 2022; 42 (8): 2313–21. doi: 10.1007/s10792-022-02228-2
39. Razmjoo H, Mikaniki M, Peyman A, et al. Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial. Eur J Ophthalmol. 2023; 33 (1): 595–601. doi: 10.1177/11206721221106142
40. Karimian F, Faramarzi A, Fekri S, et al. Comparison of Loteprednol with Fluorometholone after myopic photorefractive keratectomy. J Ophthalmic Vis Res. 2017; 12 (1): 11–6. doi: 10.4103/2008-322X.200161
41. Shokoohi-Rad S, Daneshvar R, Jafarian-Shahri M, Rajaee P. Comparison between Betamethasone, Fluorometholone and Loteprednol Etabonate on intraocular pressure in patients after keratorefractive surgery. J Curr Ophthalmol. 2017; 30 (2): 130–5. doi: 10.1016/j.joco.2017.11.008
42. Yoo YJ, Yang HK, Hwang JM. Efficacy and safety of Loteprednol 0.5% and Fluorometholone 0.1% after strabismus surgery in children. J Ocul Pharmacol Ther. 2018; 34 (6): 468–76. doi: 10.1089/jop.2017.0145
43. Raj A, Salvador-Culla B, Anwar H, et al. Long-term outcomes on de novo ocular hypertensive response to topical corticosteroids after corneal transplantation. Cornea. 2020; 39 (1): 45–51. doi: 10.1097/ICO.0000000000002142
44. Mastropasqua L, Brescia L, D'Arcangelo F, et al. Topical steroids and glaucoma filtration surgery outcomes: An in vivo confocal study of the conjunctiva. J Clin Med. 2022; 11 (14): 3959. doi: 10.3390/jcm11143959
45. Chen PQ, Han XM, Zhu YN, Xu J. Comparison of the anti-inflammatory effects of fluorometholone 0.1 % combined with levofloxacin 0.5 % and tobramycin/ dexamethasone eye drops after cataract surgery. Int J Ophthalmol. 2016; 9 (11): 1619–23. doi: 10.18240/ijo.2016.11.13
46. Balasubramaniam B, Chong YJ, Azzopardi M, Logeswaran A, Denniston AK. Topical anti-inflammatory agents for non-infectious uveitis: current treatment and perspectives. J Inflamm Res. 2022; 15: 6439–51. doi: 10.2147/JIR.S288294
47. Samudre SS, Lattanzio FA Jr, Williams PB, Sheppard JD Jr. Comparison of topical steroids for acute anterior uveitis. J Ocul Pharmacol Ther. 2004; 20 (6): 533–47. doi: 10.1089/jop.2004.20.533
48. Knutsson KA, Genovese PN, Paganoni G, et al. Evaluation of a post-operative therapy protocol after epithelium-off corneal cross-linking in patients affected by keratoconus. J Clin Med. 2022; 11 (23): 7093. doi: 10.3390/jcm11237093
49. Maychuk D.Yu., Tarkhanova A.A. Advantages of “soft steroids” in the treatment of inflammatory eye diseases. Оverview. Ophthalmology in Russia. 2021; 18 (4): 778–83 (In Russ.). doi: 10.18008/1816-5095-2021-4-778-783
50. Alwadani S. Safety and efficacy of sodium cromoglycate-fluorometholone fixed combination eye drops in allergic conjunctivitis. Saudi J Ophthalmol. 2022; 36 (1): 107–12. doi: 10.4103/sjopt.sjopt_208_21
51. Wu LQ, Chen X, Lou H, Cheng JW, Wei RL. Loteprednol etabonate in the treatment of allergic conjunctivitis: a meta-analysis. Curr Med Res Opin. 2015; 31 (8): 1509–18. doi: 10.1185/03007995.2015.1058250
52. Taniguchi J, Sharma A. Fluorometholone modulates gene expression of ocular surface mucins. Acta Ophthalmol. 2019; 97 (8): e1082-e8. doi: 10.1111/aos.14113
53. Milner MS, Beckman KA, Luchs JI, et al. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment. Curr Opin Ophthalmol. 2017; 27 (Suppl 1): 3–47. doi: 10.1097/01.icu.0000512373.81749.b7
54. Pinto-Fraga J, López-Miguel A, González-García MJ, et al. Topical fluorometholone protects the ocular surface of dry eye patients from desiccating stress: A randomized controlled clinical trial. Ophthalmology. 2016; 123 (1): 141–53. doi: 10.1016/j.ophtha.2015.09.029
55. Gao Y, Liu R, Liu Y, et al. Optical quality in patients with dry eye before and after treatment. Clin Exp Optom. 2021; 104 (1): 101–6. doi: 10.1111/cxo.13111
56. Yang CQ, Sun W, Gu YS. A clinical study of the efficacy of topical corticosteroids on dry eye. J Zhejiang Univ Sci B. 2006; 7 (8): 675–8. doi: 10.1631/jzus.2006.B0675
57. Nättinen J, Jylhä A, Aapola U, et al. Topical fluorometholone treatment and desiccating stress change inflammatory protein expression in tears. Ocul Surf. 2018; 16 (1): 84–92. doi: 10.1016/j.jtos.2017.09.003
58. Lin T, Gong L. Topical fluorometholone treatment for ocular dryness in patients with Sjögren syndrome: a randomized clinical trial in China. Medicine (Baltimore). 2015; 94 (7): e551. doi: 10.1097/MD.0000000000000551
59. Zhou X, Wang L, Zhang Z, et al. Fluorometholone inhibits high glucoseinduced cellular senescence in human retinal endothelial cells. Hum Exp Toxicol. 2022 Jan-Dec; 41: 9603271221076107. doi: 10.1177/09603271221076107
Review
For citations:
Zyryanov S.K., Butranova O.I. Topical glucocorticoids in ophthalmology: a comparative analysis of efficacy and safety. Russian Ophthalmological Journal. 2023;16(2):166-172. (In Russ.) https://doi.org/10.21516/2072-0076-2023-16-2-166-172
Views:
821
Email this article 