title: Intraocular pressure elevations with loteprednol etabonate: a retrospective chart review.
abstract: OBJECTIVE
  Ocular corticosteroids can cause elevations in intraocular pressure (IOP). The purpose of this study was to characterize the timing and severity of IOP elevations in patients receiving loteprednol etabonate 0.5% or loteprednol etabonate 0.5%/tobramycin 0.3%.
  
  
  METHODS
  A retrospective chart review was conducted at 5 academic and private practices. Any patient who experienced an elevation in IOP ≥5 mm Hg while using loteprednol etabonate or loteprednol etabonate/tobramycin was eligible for inclusion in the study. Data collected included patient demographics, medical and ophthalmic history, concomitant medications, reason for treatment, IOP, and medical and surgical interventions.
  
  
  RESULTS
  Fifty patients experienced IOP elevations after use of topical loteprednol etabonate and were included in the study. The mean (standard deviation [SD]) patient age was 58.8 (20.3) years and 66% were women. The most common reasons for prescribing loteprednol etabonate were dry eye (30%), postoperative therapy (22%), and allergic conjunctivitis (16%). Before treatment, 28% of patients had a history of open-angle glaucoma or ocular hypertension. Mean (SD) IOP before treatment was 15.5 (3.2) mm Hg and increased to a mean (SD) of 24.7 (6.5) mm Hg, a statistically significant increase of 9.2 (SD: 5.8; range: 5-29) mm Hg (P<0.0001). The median duration of treatment with loteprednol etabonate at the time of observed IOP elevation was 55 days (range: 3 days to 3 years). Twenty-four percent of patients required IOP-lowering medications and 8% required surgery to control the elevated IOP.
  
  
  CONCLUSIONS
  Alternatives to corticosteroids should be considered when long-term treatment is required for an ocular surface condition.
authors.affiliation: SeeClearly Vision, McLean, Virginia 22102, USA. rrajpal@seeclearly.com
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Rajpal
authors.forename: Donald
authors.initials: D
authors.lastname: Digby
authors.forename: Gerard
authors.initials: G
authors.lastname: D'Aversa
authors.forename: Francis
authors.initials: F
authors.lastname: Mah
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.forename: Taryn
authors.initials: T
authors.lastname: Conway
mesh_terms: D000328:Adult; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004338:Drug Combinations; D016903:Drug Monitoring; D005128:Eye Diseases / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D000069559:Loteprednol Etabonate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced*; D009883:Ophthalmic Solutions; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D014031:Tobramycin; D000069559:Loteprednol Etabonate