title: Comparison of efficacy and ocular surface toxicity of topical preservative-free methylprednisolone and preserved prednisolone in the treatment of acute anterior uveitis.
abstract: OBJECTIVE
  The aim of this study was to compare the antiinflammatory effect and ocular surface toxicity of topical nonpreserved methylprednisolone sodium succinate 1% and preserved prednisolone acetate suspension 1% for the management of acute anterior uveitis (AAU).
  
  
  METHODS
  In this prospective, randomized, investigator-masked, comparative clinical trial, patients with mild-to-moderate noninfectious AAU were assigned randomly to receive either hourly nonpreserved methylprednisolone 1% (group A) or preserved prednisolone 1% (group B) eye drops followed by a 2-week tapering regimen. Anterior chamber cells and flare were clinically evaluated for the objective comparison of the antiinflammatory effect. The main outcome measure was the percentage of patients with a resolution of inflammation (anterior chamber cells <1+) on day 14. Ocular surface toxicity was assessed by means of the corneal fluorescein staining score, tear breakup time, Schirmer I test, and questionnaire-based grading of ocular discomfort parameters.
  
  
  RESULTS
  Seventy-two eyes of 68 patients were studied, of which 38 eyes were enrolled in group A and 34 eyes were enrolled in group B. On day 14, 76.3% of the patients in group A had resolution of inflammation compared with 70.6% of the patients in group B, proving noninferiority (χ = 0.303, P = 0.582). The mean anterior chamber cell grade reduction for patients in group A was similar to that in group B (2.52 vs. 2.86, respectively; P = 0.92). Group A patients showed significantly lower corneal fluorescein staining scores (P < 0.001) and reported milder subjective ocular discomfort (0.55 vs. 1.43, P = 0.01) as compared with group B.
  
  
  CONCLUSIONS
  Both preparations demonstrated equal antiinflammatory effects for the treatment of AAU. Nonpreserved methylprednisolone eye drops exhibited a significantly lower ocular surface toxicity profile and milder subjective discomfort when compared with that exhibited by preserved prednisolone.
authors.affiliation: *Noor Ophthalmic Research Center, Noor Eye Hospital, Tehran, Iran; †Ophthalmology Department, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; ‡Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran; §Ocular Inflammation & Immunology Service, Singapore National Eye Centre, Singapore; ¶National University of Singapore, Singapore; ‖Singapore Eye Research Institute, Singapore; **Duke-National University of Singapore Post Graduate Medical School, Singapore.
authors.forename: Alireza
authors.initials: A
authors.lastname: Hedayatfar
authors.forename: Hassan
authors.initials: H
authors.lastname: Hashemi
authors.forename: Soheila
authors.initials: S
authors.lastname: Asgari
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D003315:Cornea / Q000187:drug effects; D004311:Double-Blind Method; D005143:Eyelids / Q000187:drug effects; D005260:Female; D015590:Fluorophotometry; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000502:physiology; D016896:Treatment Outcome; D014606:Uveitis, Anterior / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical; D008776:Methylprednisolone Hemisuccinate; C009935:prednisolone acetate; D011239:Prednisolone