1 Intraocular Pressure Spikes in Difluprednate Ophthalmic Emulsion 0.05% for Postoperative Cataract Inflammation by Melissa M. Cable, FAAO, FACS Discover Vision Centers *The author of this poster has received research funding and travel expense reimbursement from Alcon, Bausch and Lomb, ISTA and Inspire

2 Purpose To report intraocular pressure spikes in a consecutive series of 100 uncomplicated postoperative cataract patients using difluprednate ophthalmic emulsion 0.05% bid. Setting: one surgeon in one clinic

3 Methods Retrospective chart review was performed for patients with 5mm Hg or more elevation compared with baseline intraocular pressure.

4 Results In a series of 100 uncomplicated phacoemulsification patients receiving bid dosing of difluprednate, average age 74.4 years, men and women, 5% of patients responded with ocular hypertension. Of those 5, 100% were previously diagnosed with open angle glaucoma. Average baseline IOP was 17.8 mm Hg, average IOP max was 35.4 mm Hg with a range of mm Hg. Average increase in IOP was 17.8 mm Hg, with an average percentage increase over baseline of 100.2%.

5 Results 60% of IOP spikes were noted on POD1, 40% by POD7. IOP was managed by discontinuation of Durezol and/or addition of topical glaucoma meds. All patients responded to treatment quickly returning to baseline within 1-2 days.

6 Conclusion Difluprednate given bid in uncomplicated phacoemulsification patients can cause significant and early elevations of intraocular pressure. Reported rates of ocular hypertension in bid dosing of difluprednate is 3- 4%.[i] The rate of ocular hypertension in this series is 5% with 100% of responders having a history of primary open angle glaucoma. Patients with a history of glaucoma may be more likely to respond to difluprednate even if they are not known steroid responders.[i] [i] Korenfeld, Michael. “Difluprednate: changing the landscape of ocular pharmacology,” Expert Rev. Ophthalmology, 3(6), (2008). Pp

7 About the Author: Melissa M. Cable, MD, FAAO, FACS, is a board-certified ophthalmologist with Discover Vision Centers in Kansas City, MO., specializing in gentle no-stitch cataract surgery, ocular disease and cosmetic procedures. Dr. Cable graduated at the top 5% of her class in both her undergraduate and medical degree programs at Louisiana State University. She completed a residency in ophthalmology at the University of Missouri—Kansas City before joining Discover Vision Centers. Dr. Cable is one of only six partners in the company. With over 30 doctors, 9 locations and 3 surgery centers located in the Kansas City Metro area, Discover Vision Centers has become one of the largest private ophthalmic medical-surgical practices in the United States.

8 Thank you! Contact Information: Melissa M. Cable, MD, FAAO, FACS Discover Vision Centers 4741 S. Cochise Drive Independence, MO Phone: (816) Fax: (816)