title: Efficacy and potential complications of difluprednate use for pediatric uveitis.
abstract: OBJECTIVE
  To evaluate the clinical effect of topical difluprednate in pediatric patients for treatment of noninfectious uveitis.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Twenty-six eyes of 14 pediatric patients with noninfectious uveitis who were treated with topical difluprednate were evaluated. Anterior and posterior cell grade, visual acuity, intraocular pressure (IOP), and cystoid macular edema (CME) were recorded at each visit. Main outcome measures were changes in anterior segment cell, CME, visual acuity, and IOP and development of a visually significant cataract.
  
  
  RESULTS
  A significant (≥ 2-grade decrease or decrease to 0 in anterior segment cell) reduction in anterior segment inflammation was observed during treatment with topical difluprednate in 88% of eyes (22/25) when used as an adjuvant to systemic immunomodulatory therapy. In addition, improvement in CME associated with uveitis was seen in response to topical therapy with difluprednate in 78% of eyes with CME (7/9). A significant IOP response (IOP increase of ≥ 10 mm Hg from baseline and IOP ≥ 24 mm Hg) was seen in 50% of eyes (13/26) and in 50% of patients (7/14); 3 eyes of 2 patients required glaucoma surgery. Cataract formation or progression was observed in 39% of eyes (10/26) and in 43% of patients (6/14); 5 eyes of 3 patients required cataract surgery.
  
  
  CONCLUSIONS
  Difluprednate is an effective agent for both control of anterior segment inflammation and reduction of CME in pediatric patients with uveitis when used as an adjuvant to systemic immunomodulatory therapy. A high rate of steroid-induced IOP elevation and cataract formation is seen in this population. Close monitoring of pediatric patients receiving difluprednate is recommended.
authors.affiliation: Department of Ophthalmology, University of Washington School of Medicine, Seattle, 98104, USA. mas12@uw.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Slabaugh
authors.forename: Erin
authors.initials: E
authors.lastname: Herlihy
authors.forename: Sharel
authors.initials: S
authors.lastname: Ongchin
authors.forename: Russell N
authors.initials: RN
authors.lastname: van Gelder
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D001082:Aqueous Humor / Q000166:cytology; D002386:Cataract / Q000139:chemically induced; D002648:Child; D005260:Female; D005477:Fluprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008269:Macular Edema / Q000503:physiopathology; D008297:Male; D009798:Ocular Hypertension / Q000139:chemically induced; D009883:Ophthalmic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D005477:Fluprednisolone; C015808:difluprednate